Peptic Ulcer Disease (cont.)
How are peptic ulcers diagnosed?
The diagnosis of an ulcer is made by either a barium upper gastrointestinal X-ray (upper GI series) or an upper gastrointestinal endoscopy (EGD or esophagogastroduodenoscopy). The barium upper GI X-ray is easy to perform and involves no risk (other than exposure to radiation) or discomfort. Barium is a chalky substance that is swallowed. It is visible on X- rays, and allows the outline of the stomach to be seen on X-rays; however, barium X-rays are less accurate and may miss ulcers in up to 20% of the time.
An upper gastrointestinal endoscopy is more accurate than X-rays, but involves sedation of the patient and the insertion of a flexible tube through the mouth to inspect the esophagus, stomach, and duodenum. Upper endoscopy has the added advantage of having the capability of removing small tissue samples (biopsies) to test for H. pylori infection. Biopsies are also examined under a microscope to exclude a cancerous ulcer. While virtually all duodenal ulcers are benign, gastric ulcers can occasionally be cancerous. Therefore, biopsies often are performed on gastric ulcers to exclude cancer.