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The diagnosis is mainly established based on the characteristic symptoms. The stomach pain is usually the first to signal a peptic ulcer. In some cases, doctors may treat ulcers without diagnosing them with specific tests and observe if the symptoms resolve, meaning their primary diagnosis was accurate. Confirming the diagnosis is made with the help of tests such as endoscopies or barium contrast x-rays. The tests are typically ordered if the symptoms do not resolve after a few weeks of treatment, or when they first appear in a person who is over age 45 or who has other symptoms such as weight loss, because stomach cancer can cause similar symptoms. Also, when severe ulcers resist treatment, particularly if a person has several ulcers or the ulcers are in unusual places, a doctor may suspect an underlying condition that causes the stomach to overproduce acid. An esophagogastroduodenoscopy (EGD), a form of endoscopy, also known as a gastroscopy, is carried out on patients in whom a peptic ulcer is suspected. By direct visual identification, the location and severity of an ulcer can be described. Moreover, if no ulcer is present, EGD can often provide an alternative diagnosis. One of the reasons why blood tests are not reliable on establishing an accurate peptic ulcer diagnosis on their own is their inability to differentiate between past exposure to the bacteria and current infection. Additionally, a false-negative is possible with a blood test if the patient has recently been taking certain drugs, such as antibiotics or proton pump inhibitors. The diagnosis of Helicobacter pylori can be made by:
• • • •
Urea breath test (noninvasive and does not require EGD); Direct culture from an EGD biopsy specimen; this is difficult to do, and can be expensive. Most labs are not set up to perform H. pylori cultures; Direct detection of urease activity in a biopsy specimen by rapid urease test; Measurement of antibody levels in blood (does not require EGD). It is still somewhat controversial whether a positive antibody without EGD is enough to warrant eradication therapy; Stool antigen test; Histological examination and staining of an EGD biopsy.
The breath test uses radioactive carbon atom to detect H. pylori. To perform this exam the patient will be asked to drink a tasteless liquid which contains the carbon as part of the substance that the bacteria breaks down. After an hour, the patient will be asked to blow into a bag that is sealed. If the patient is infected with H. pylori, the breath sample will contain radioactive carbon dioxide. This test provides the advantage of being able to monitor the response to treatment used to kill the bacteria.
These borders are not elevated or irregular in the acute form of peptic ulcer. Gastric ulcers are most often localized on the lesser curvature of the stomach. air will leak from the inside of the gastrointestinal tract (which always contains some air) to the peritoneal cavity (which normally never contains air). the base of the ulcer shows 4 zones: inflammatory exudate. with a smooth base and perpendicular borders. Therefore. as a consequence of the parietal scarring.The possibility of other causes of ulcers. produced by acid-pepsin aggression. If a peptic ulcer perforates. During the active phase. In the ulcerative form of gastric cancer the borders are irregular. granulation tissue and fibrous tissue. though the warning labels of some bismuth subsalicylate products indicate that the product should not be used by someone with an ulcer. 2 to 4 cm diameter. most are also a consequence of chronic H. is an omen of perforated peptic ulcer disease. Bismuth compounds may actually reduce or even clear organisms. Ulcer margins are perpendicular and present chronic gastritis. gas in the peritoneal cavity. This is especially true in ulcers of the greater (large) curvature of the stomach. shown on an erect chest X-ray or supine lateral abdominal X-ray. . pylori infection. This leads to "free gas" within the peritoneal cavity. notably malignancy (gastric cancer) needs to be kept in mind. The ulcer is a round to oval parietal defect ("hole"). which may be a side-effect of the NSAIDs. the gas will float to a position underneath the diaphragm. Microscopic appearance A gastric peptic ulcer is a mucosal defect which penetrates the muscularis mucosae and muscularis propria.  Treatment Younger patients with ulcer-like symptoms are often treated with antacids or H2 antagonists before EGD is undertaken. as when having a chest X-ray. Surrounding mucosa may present radial folds.[clarification needed] Patients who are taking nonsteroidal anti-inflammatories (NSAIDs) may also be prescribed a prostaglandin analogue (Misoprostol) in order to help prevent peptic ulcers. Macroscopic appearance A benign gastric ulcer (from the antrum) of a gastrectomy specimen. If the patient stands erect. fibrinoid necrosis. The fibrous base of the ulcer may contain vessels with thickened wall or with thrombosis. regular but with elevated borders and inflammatory surrounding in the chronic form.
This test outlines your esophagus. Amoxicillin. such as: • • Blood test. In complicated. the most effective treatments are combinations of 2 antibiotics (e. pylori infection is present. pylori. amoxicillin + clarithromycin + metronidazole) may be used together with a PPI and sometimes with bismuth compound. tasteless liquid. The advantage of the breath test is that it can monitor the effectiveness of treatment used to eradicate H. pylori. This test checks for the presence of H. your breath sample will contain the radioactive carbon in the form of carbon dioxide. • • Stool antigen test. Tetracycline. For the test. pylori in stool samples. long-term higher dose PPIs are often used. If you're infected with H. you blow into a bag. In the absence of H. detecting whether the bacteria have been killed or eradicated. A disadvantage of this test is that it sometimes can't differentiate between past exposure and current infection. you may have to undergo diagnostic tests.g. Recurrence of infection can occur and retreatment may be required. injection. It's useful both in helping to diagnose H. you swallow a white.g.When H. Breath test. Metronidazole) and 1 proton pump inhibitor (PPI). This test checks for H. metallic liquid (containing barium) that coats your digestive tract and makes an ulcer more visible. but not all. The liquid contains radioactive carbon as part of a substance (urea) that will be broken down by H. relief of symptoms and eventual healing of ulcers. During the X-ray. Perforated peptic ulcer is a surgical emergency and requires surgical repair of the perforation. surgical procedures (like "highly selective vagotomy") for uncomplicated peptic ulcers became obsolete. Most bleeding ulcers require endoscopy urgently to stop bleeding with cautery. Clarithromycin. which is then sealed. Treatment of H. pylori usually leads to clearing of infection. This procedure uses a radioactive carbon atom to detect H. or clipping. Upper gastrointestinal (upper GI) X-ray. treatment-resistant cases. Tests and diagnosis In order to detect an ulcer. stomach and duodenum. An upper GI X-ray can detect some ulcers. 3 antibiotics (e. you drink a small glass of clear. sometimes together with a bismuth compound. . such as antibiotics or proton pump inhibitors. Additionally. pylori. if necessary with other antibiotics. pylori. Since the widespread use of PPI's in the 1990s. An effective first-line therapy for uncomplicated cases would be Amoxicillin + Metronidazole + Pantoprazole (a PPI). pylori antibodies. a false-negative is possible if you've recently been taking certain drugs. Less than an hour later. pylori. pylori infection and in monitoring the success of treatment.
narrow tube with an attached camera is threaded down your throat and esophagus into your stomach and duodenum. Lifestyle and home remedies Before the discovery of H. weight loss. he or she may remove small tissue samples (biopsy) near the ulcer. The same is true for stress because stress may increase acid. doctors often advised people with ulcers to eat a restricted diet and reduce the amount of stress in their lives. These include avoiding spicy and fatty foods. such as difficulty swallowing. avoiding reclining after meals. These samples are examined under a microscope to rule out cancer. raising the head of your bed and reducing your weight. Depending on where the ulcer is found. If you use pain relievers regularly. it's still advisable to watch what you eat and to control stress. Your doctor will perform this test if you have other signs or symptoms. Smoking also increases stomach acid. your doctor may recommend a repeat endoscopy after two to three months to confirm that the ulcer is healing. while an ulcer is healing. If stress is severe. alcohol and NSAIDs also may help to control acid reflux. A biopsy can also identify the presence of H. or your doctor may perform endoscopy first. causing inflammation and bleeding. Avoid nonsteroidal anti-inflammatory drugs (NSAIDs). Smoking may interfere with the protective lining of the stomach. However. Your doctor may also give you these helpful suggestions: • • • • Don't smoke. If you have an esophageal ulcer — usually associated with acid reflux — you can take several steps to help manage acid reflux. others). it may delay the healing of an ulcer. vomiting (particularly vomiting red or black material that looks like coffee grounds). these factors are no longer of as much importance. pylori in your stomach lining. making your stomach more susceptible to the development of an ulcer. This procedure may follow an upper GI X-ray if the X-ray suggests a possible ulcer. . In this more sensitive procedure. your doctor can view your upper digestive tract and identify an ulcer. pylori. Now that food and stress have been eliminated as direct causes of ulcers. black stools or anemia. Avoiding smoking. If your doctor detects an ulcer. Limit or avoid alcohol. With this instrument. use acetaminophen (Tylenol.• Endoscopy. Control acid reflux. Excessive use of alcohol can irritate and erode the mucous lining in your stomach and intestines. Acidic or spicy foods may increase ulcer pain. a long.
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