Peptic ulcer

Peptic ulcer is usually a non-malignant ulcer of the stomach (called gastric ulcer) or duodenum (called duodenal ulcer). About 4 % of gastric ulcers are caused by malignant tumour, which is why ulcers of stomach are controlled. Duodenal ulcers are non-malignant. By far most instances are now known to be due to Helicobacter pylori, a spiral-shaped bacterium that lives in the acid environment of the stomach. These ulcers can also be caused or worsened by drugs such as Aspirin and other NSAIDs.

Diagnosis

In patients in whom peptic ulcer is suspected, esophagogastroduodenoscopy (EGD, a form of endoscopy) is indicated. By direct visual identification, the location and severity of an ulcer can be described. Moreover, if no ulcer is present, EGD can often provide an alternative diagnosis.

Related Topics:
Esophagogastroduodenoscopy - Endoscopy

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The diagnosis of Helicobacter pylori can be by:

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• Biopsy during EGD;
• Breath testing (does not require EGD);
• Direct culture from an EGD biopsy specimen;
• Direct detection of urease activity in a biopsy specimen;
• Measurement of antibody levels in blood (does not require EGD). It is still slightly controversial whether a positive antibody without EGD is enough to warrant eradication therapy.

The possibility of other causes of ulcers, notably malignancy (gastric cancer) needs to be kept in mind. This is especially true in ulcers of the large curvature of the stomach; most are also a consequence of chronic H. pylori infection.

Related Topics:
Malignancy - Gastric cancer - Stomach

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