It is important for patients experiencing symptoms of a peptic to consult a physician (often a gastroenterologist) because ulcers may not heal properly without medical attention. Peptic ulcers are usually diagnosed following an evaluation of medical history, a physical examination and diagnostic tests. Some physicians and gastroenterologists may simply treat a patient for peptic ulcers if the medical history and physical exam strongly suggest their presence. This is particularly likely if the patient is experiencing the characteristic abdominal pain. However, tests are usually needed to confirm the diagnosis and determine the cause of the ulcers.

Endoscopy is usually the first test used to diagnose peptic ulcers. While the patient is mildly sedated, a tiny camera attached to a thin tube is inserted through the mouth and esophagus into the stomach and duodenum. Endoscopy can be used to view the lining and sometimes obtain a tissue sample. The biopsy, or laboratory examination, of this tissue sample can be used to determine if an ulcer is cancerous or to identify an infection with the Helicobacter pylori (H. pylori) bacteria.

Barium x-rays may also be used to determine the severity and size of an ulcer. In an upper GI barium test, the patient consumes barium before an x-ray is performed. Barium acts as a contrast medium to make the intestinal organs stand out better on an x-ray. Barium x-rays were formerly the most commonly used diagnosis method for peptic ulcers. However, endoscopy has proven more reliable, especially in detecting smaller ulcers. In addition, endoscopy provides the option of removing tissue for biopsy.

Other tests may also be used to help determine the particular cause of peptic ulcers. Blood tests may be used to detect anemia and antibodies to H. pylori infections. The presence of these antibodies demonstrates that the patient has been infected at some point in the past. It does not necessarily indicate a current infection. Breath tests may be used to measure the activity of urease, an enzyme produced by H. pylori. Fecal tests may be used to detect active infections of H. pylori and signs of gastrointestinal bleeding that may not otherwise be noticeable.

In addition, researchers are currently investigating easier and more cost effective methods of identifying the presence of H. pylori bacteria. One such method that shows a great deal of promise is a simple string test in which patients swallow a capsule that contains a string. A portion of the string is held outside the patient’s mouth, allowing for easy retrieval. The string is then removed from the mouth and analyzed for the presence of the bacteria.