Peptic ulcer screening and diagnosis

In order to detect an ulcer, your doctor may have you undergo the following diagnostic tests:

• Upper gastrointestinal (upper GI) X-ray. Your doctor may begin with this test, which outlines your esophagus, stomach and duodenum. During the X-ray, you swallow a white, metallic liquid (containing barium) that coats your digestive tract and makes an ulcer more visible. An upper GI X-ray can detect some ulcers, but not all.
• Endoscopy. This procedure may follow an upper GI X-ray if the X-ray suggests a possible ulcer, or your doctor may perform endoscopy first. In this more sensitive procedure, a long, narrow tube with an attached camera is threaded down your throat and esophagus into your stomach and duodenum. With this instrument, your doctor can view your upper digestive tract and identify an ulcer.

If your doctor detects an ulcer, he or she may remove small tissue samples (biopsy) near the ulcer. These samples are examined under a microscope to rule out cancer. A biopsy can also identify the presence of H. pylori in your stomach lining. Depending on where the ulcer is found, your doctor may recommend a repeat endoscopy after two to three months to confirm that the ulcer is healing.

Additional tests
In addition to a biopsy, these other tests can determine if the cause of your ulcer is H. pylori infection:

• Blood test. This test checks for the presence of H. pylori antibodies. A disadvantage of this test is that it sometimes can't differentiate between past exposure and current infection. After H. pylori bacteria have been eradicated, you may still have a positive result for many months.

• Breath test. This procedure uses a radioactive carbon atom to detect H. pylori. First, you blow into a small plastic bag, which is then sealed. Then, you drink a small glass of clear, tasteless liquid. The liquid contains radioactive carbon as part of a substance (urea) that will be broken down by H. pylori. Thirty minutes later, you blow into a second bag, which also is sealed. If you're infected with H. pylori, your second breath sample will contain the radioactive carbon in the form of carbon dioxide.

  The advantage of the breath test is that it can monitor the effectiveness of treatment used to eradicate H. pylori, detecting when the bacteria have been killed or eradicated. With the blood test, H. pylori antibodies may sometimes still be present a year or more after the infection is gone.

• Stool antigen test. This test checks for H. pylori in stool samples. It's useful both in helping to diagnose H. pylori infection and in monitoring the success of treatment.

Peptic ulcer when to seek medical advice

An ulcer isn't something that you should treat on your own, without a doctor's help. Over-the-counter antacids and acid blockers may relieve the gnawing pain, but the relief is short-lived. If you have signs or symptoms of an ulcer, see your doctor. With a doctor's help, you can find prompt relief of ulcer pain as well as a complete healing of the ulcer.

Peptic ulcer Causes

Depending on their location, peptic ulcers have different names:

• Gastric ulcer. This is a peptic ulcer that occurs in your stomach.
• Duodenal ulcer. This type of peptic ulcer develops in the first part of the small intestine (duodenum).
• Esophageal ulcer. An esophageal ulcer is usually located in the lower section of your esophagus. It's often associated with chronic gastroesophageal reflux disease (GERD).

The culprit in most cases
Although stress and spicy foods were once thought to be the main causes of peptic ulcers, doctors now know that the cause of most ulcers is the corkscrew-shaped bacterium Helicobacter pylori (H. pylori).

H. pylori lives and multiplies within the mucous layer that covers and protects tissues that line the stomach and small intestine. Often, H. pylori causes no problems. But sometimes it can disrupt the mucous layer and inflame the lining of the stomach or duodenum, producing an ulcer. One reason may be that people who develop peptic ulcers already have damage to the lining of the stomach or small intestine, making it easier for bacteria to invade and inflame tissues.

H. pylori is a common gastrointestinal infection around the world. In the United States, one in five people younger than 30 and half the people older than 60 are infected. Although it's not clear exactly how H. pylori spreads, it may be transmitted from person to person by close contact, such as kissing. People may also contract H. pylori through food and water.

H. pylori is the most common, but not the only, cause of peptic ulcers. Besides H. pylori, other causes of peptic ulcers, or factors that may aggravate them, include:

• Regular use of pain relievers. Nonsteroidal anti-inflammatory drugs (NSAIDs) can irritate or inflame the lining of your stomach and small intestine. The medications are available both by prescription and over-the-counter. Nonprescription NSAIDs include aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve) and ketoprofen (Orudis KT). To help avoid digestive upset, take NSAIDs with meals.

  NSAIDs inhibit production of an enzyme (cyclooxygenase) that produces prostaglandins. These hormone-like substances help protect your stomach lining from chemical and physical injury. Without this protection, stomach acid can erode the lining, causing bleeding and ulcers.

• Smoking. Nicotine in tobacco increases the volume and concentration of stomach acid, increasing your risk of an ulcer. Smoking may also slow healing during ulcer treatment.
• Excessive alcohol consumption. Alcohol can irritate and erode the mucous lining of your stomach and increases the amount of stomach acid that's produced. It's uncertain, however, whether this alone can progress into an ulcer or whether other contributing factors must be present, such as H. pylori bacteria or ulcer-causing medications, such as NSAIDs.
• Stress. Although stress per se isn't a cause of peptic ulcers, it's a contributing factor. Stress may aggravate symptoms of peptic ulcers and, in some cases, delay healing. You may undergo stress for a number of reasons — an emotionally disturbing circumstance or event, surgery, or a physical trauma, such as a burn or other severe injury.