Peptic Ulcers - Diagnosis

It should be noted that such tests are not as accurate as endoscopy, an invasive procedure, which is needed to confirm a diagnosis of H. pylori. The breath and stool tests, however, can be particularly useful after treatment to determine if patients are cured.

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Managing the Test Results: Test and Treat. Depending on the results of the screening tests, some doctors take the following steps:

Approach for Non-Infected Individuals. People who do not have evidence of H. pylori on a blood test or breath are typically given a four-week course of acid-suppressing medication, usually proton-pump inhibitors (PPIs), such as omeprazole (Prilosec).
Approach for H-Pylori Infected Individuals. Patients who have evidence of bacterial infection are given antibiotics. If this does not relieve symptoms, they are given another six-week course of omeprazole (Prilosec). (Whether to give antibiotics to infected patients with non-ulcer dyspepsia is controversial, however, and discussed in the section What Are the Guidelines for Treating Peptic Ulcers Caused by H. pylori?)

If symptoms persist, then usually panendoscopy, also know simply as endoscopy, is performed. This is an invasive procedure, but only endoscopy allows a biopsy of stomach tissue, making it the most accurate test.

Experts debate on whether endoscopy should be performed on all patients who do not respond to initial medication. It does not appear to add any useful information on treatment choices, however, unless there is evidence or suspicion of bleeding or serious complications.

Panendoscopy

Panendoscopy (also called gastroscopy or, simply, endoscopy) is a procedure that evaluates the esophagus, stomach, and duodenum using an endoscope (a long thin tube containing a tiny video camera). When used with biopsy, panendoscopy is the most accurate procedure for detecting the presence of peptic ulcers, bleeding, and stomach cancer. It can also be used to confirm a diagnosis of H. pylori.

Appropriate Candidates for Panendoscopy. Panendoscopy is invasive and expensive and not suitable for everyone with dyspepsia. Most individuals with these symptoms are managed effectively after simple screening methods.

Panendoscopy is usually reserved for patients with dyspepsia who also have risk factors for ulcers, stomach cancer, or both. Such factors include the following:

Having so-called "alarm" symptoms (unexplained weight loss, gastrointestinal bleeding, vomiting, difficulty in swallowing, or anemia).
Being over 45 (when the risk for stomach cancer increases).