Diagnosis
The diagnosis of duodenal ulcer consists of several steps. First of all, a detailed patient interview (anamnesis) is made with subsequent examination of the patient. A rectal examination by palpation is seldom carried out during which non-visible – so-called occult – blood in the stool can be detected.
A reliable diagnosis is made by means of a gastrointestinal endoscopy (esophago-gastro-duodenoscopy), whereby the examining doctor can look at the ulcer himself and take several small samples of the affected intestinal mucosa, which are then examined. During this procedure, either the throat is anaesthetized with a spray or a short anaesthetic is given. Then the examiner inserts the gastroscope through the mouth and passes through the esophagus and stomach to the duodenum.
With a camera, the mucous membrane of the esophagus, stomach and duodenum can be assessed. To be able to diagnose an ulcer reliably, a sample (biopsy) must be taken from the affected area. This is done during a gastroscopy.
This sample is then sent to a pathological institute, where it is examined in fine tissue (under the microscope). In the end, the diagnosis can only be made under the microscope. The main focus is on Helicobacter pylori infection and malignant degeneration of the cells.
The sample must be taken because a certain percentage of the ulcers can become malignant (malignant degeneration) and one does not want to overlook them. The test for Helicobacter pylori is done to clarify the origin of the duodenal ulcer. If bacteria are found, these are assumed to be the cause.
If no bacteria are found, the most likely cause is taking medication (certain painkillers). If there is acute suspicion of a perforation of the intestinal wall, an X-ray examination should be attempted. The patient swallows an X-ray contrast medium in the form of a porridge while the upper abdomen is X-rayed.
It can be observed whether the contrast medium escapes from holes in the intestinal wall. This clearly indicates a perforation. If no improvement is achieved even after long therapy, long-term pH measurement can be performed. In this procedure, the pH value in the duodenum is measured over a period of 24 hours with the aid of an electrode. Elevated acid values may be seen as a sign of a functional disorder and as a cause of duodenal ulcer.Ultrasound of the abdomen
