Peptic Ulcers - Diagnosis

Diagnosis

Peptic ulcers are always suspected in patients with persistent dyspepsia (e.g., bloating, belching, abdominal pain). Dyspepsia, however, occurs in 20% - 40% of people who live in industrialized nations, and only about 15% - 25% of these people actually have an ulcer. There are a number of steps needed to make an accurate diagnosis of ulcers.

Medical and Family History

The doctor will ask for a thorough report of a patient's dyspepsia and other important symptoms, such as weight loss or fatigue, any present and past medication use (especially chronic use of NSAIDs), family members with ulcers, and drinking and smoking habits.

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Ruling Out Other Disorders

In addition to peptic ulcers, a number of conditions, notably gastroesophageal reflux disease (GERD and irritable bowel syndrome), cause dyspepsia. In most cases, however, no cause can be determined. (In such cases, the symptoms are referred to collectively as functional dyspepsia.)

Peptic ulcer symptoms, notably abdominal and chest pain, may resemble those of other conditions, such as gallstones, or even the chest pain of heart attack. Certain features may help to distinguish these different conditions. However, symptoms often overlap, and it is impossible to make a diagnosis based on symptoms alone. A number of tests are needed.

The following are some disorders that may be confused with peptic ulcers:

• GERD. About half of patients with GERD also have dyspepsia. With GERD or other problems in the esophagus (food pipe), however, the main symptom is usually heartburn, a burning pain that radiates up to the throat. It typically develops after meals and is often relieved by antacids. The patient may have difficulty swallowing, and there is often regurgitation or acid reflux. [See In-Depth Report #85: Gastroesophageal Reflux Disease.]
• Heart Events. Pain due to heart events, such as angina or a heart attack, is more likely to occur with exercise, and it may radiate to the neck, jaw, or arms. In addition, patients typically have distinct risk factors for heart disease, such as a family history, smoking, high blood pressure, obesity, and high cholesterol. [See In-Depth Report #12: Heart Attack.]
• Gallstones. The primary symptom in gallstones is typically a steady gripping or gnawing pain on the right side (under the rib cage), which can be quite severe and can radiate to the upper back. Some patients experience the pain behind the breast bone. The pain is often precipitated by a fatty or heavy meal, but gallstones almost never cause dyspepsia. [See In-Depth Report #10: Gallstones and Gallbladder Disease.]
• Irritable Bowel Syndrome. Irritable bowel syndrome can cause dyspepsia, nausea and vomiting, bloating, and abdominal pain. It occurs more often in women.