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Diagnosis

It is important to diagnose ulcers quickly by detecting localized erosions in the stomach and duodenum and treat them aggressively, before they worsen. Upper endoscopy, which may be used to diagnose an ulcer, involves using a flexible tube with a special fiber optic cable to provide real-time images of the inside of the stomach and duodenum. If stomach cancer is suspected, the ulcer can be biopsied through the same flexible tube. Endoscopy is performed under sedation, but it still a very invasive test.

An upper GI series (UGI) is a less invasive test that may be used to diagnose ulcers. In this test the patient swallows a contrast solution (barium), which covers and fills the lining of the esophagus, the stomach, and the duodenum. Upon imaging, barium appears particularly dense in an ulcer. Most ulcers "trap" the barium, so that when the intact lining loses its barium covering, the ulcer remains filled with the dense material. Ulcers in the GI tract lining also show other signs of inflammation on fluoroscopy, such as thick, inflamed folds that radiate away from the ulcer.

Sometimes, gastric and duodenal ulcers can occur areas such as the end of the stomach, in the passage into the duodenum (pyloric channel). Inflammation and swelling may cause this channel to narrow substantially or become completely obstructed. In that case, the stomach cannot empty, and food, liquids, and secretions build up. The stomach can become extremely dilated and may need to be emptied using a tube that passes through the nose into the stomach (nasogastric tube). Once the stomach is emptied, the area in question can be evaluated by either UGI series or an upper endoscopy.

In some cases, the ulcer gets so deep that it perforates through the gastrointestinal lining, allowing air and material from the GI tract to pass into the abdominal cavity, which is sterile. This may cause a number of complications, including peritonitis (inflammation of the lining of the abdominal cavity). A perforated ulcer requires immediate surgery.

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