How to Diagnose an Ulcer

Asking the patient about the medical history he or she has gone through (anamnesis) is the first step in any examination – even if an ulcer is suspected. The medical history can only provide clues to an ulcer, not certainty, because there are no specific complaints. Therefore, the main focus is to ask about previous (endoscopically confirmed) ulcer episodes and their therapy, possibly the composition of previously taken antibiotic combinations to combat Helicobacter pylori.

Medical history as part of the diagnostic process

When questioning the patient, information on the duration of any tarry stools and any accompanying vomiting of blood continues to be particularly important. Alcohol, pain medication, cortisone, nicotine in the history also play a crucial role, as these substances attack the protective layer of the stomach and thus promote the development of gastric ulcers.

Physical examination for suspected ulcer

After taking a medical history, a detailed physical examination is performed. Palpation of the abdomen is unremarkable in most cases because of the relatively mild symptoms. If gastritis is particularly pronounced and peptic ulcers are present at the same time, tenderness in the pit of the stomach may occur. An ulcer perforation, on the other hand, can lead to tightening of the abdominal wall up to a board-hard abdomen or cause ileus symptoms (intestinal paralysis) with absent bowel sounds.

Signs of anemia, such as poor concentration, rapid fatigability, and pale skin color, may indicate repeated minor blood loss from the upper gastrointestinal tract.

Endoscopy of the esophagus, stomach, and small intestine.

Ultimately, the presence of a gastric or duodenal ulcer is evidenced by esophago-gastro-duodenoscopy (endoscopy of the esophagus, stomach, and small intestine). Gastroscopy of the stomach and small intestine with the removal of a tissue sample is the method of choice for examining this part of the digestive tract. Since an ulcer can also hide a malignant degeneration (stomach cancer), the tissue sample taken is examined microscopically for tumor cells.

Bleeding from the upper gastrointestinal tract can lead to a life-threatening situation, so that mirror examination is an unavoidable examination method. Not only can the mucous membranes of the individual organs be examined, but bleeding can be stopped, for example, by injection. In this procedure, adrenaline (stress hormone of the adrenal gland) is injected into the source of bleeding, thereby constricting the vessel to such an extent that the bleeding stops. A rapid urease test is also performed to see if a Helicobacter pylori infection is responsible for the peptic ulcer.

Determine bleeding activity

The bleeding activity of a peptic ulcer is done according to a specific classification (Forrest). For example, a type Ia ulcer is acutely spurting bleeding, whereas type Ib is only oozing bleeding. In an IIa ulcer, the vascular stump is visible but not bleeding. An IIb ulcer is covered with a blood clot, and the type III ulcer is already in the healing phase.

X-ray not mandatory

An x-ray survey is required only if the ulcer destroys the stomach wall to the point that wall breakdown into the abdominal cavity and an acute abdomen (acute abdomen) are suspected. Determination of blood count (white blood cells, red blood cells, blood pigment) is necessary to detect possible anemia. Anemia may be the result of bleeding of the gastric mucosa.

Prognosis

The prognosis of ulcer disease is favorable. In Germany, 6 of every 100,000 inhabitants die from gastric ulcer, and 4 of every 100,000 die from duodenal ulcer. Fatal complications primarily affect patients older than 70 years, men twice as often as women.