Diagnostics

The most accurate test to confirm the diagnosis. Other clinical applications include:

• Malignancy screening: to differentiate PUD from gastric cancer

  • Visualization of the lesions

  • Biopsy sampling

• Invasive H. pylori testing

• Simultaneous therapeutic measures, e.g., hemostasis treatment with electrocautery for active bleeding

• Gastric ulcers

  • Biopsies are recommended in most cases.

  • Multiple biopsies are recommended.

    • From the edge and base of the ulcer (essential to rule out malignancy, which is not uncommon in gastric ulcers)

    • Multiple biopsies from different areas of the stomach lining, including those not surrounding the ulcer (to test for H. pylori)

• Duodenal ulcers

  • Obtain biopsies from ulcers with endoscopic features that suggest malignancy.

  • Duodenal ulcers are usually benign and do not require routine biopsy.

To rule out gastric cancer, patients with suspicious gastric ulcers should undergo follow-up EGD and histology until the ulcer has healed completely!

Consider testing for rare causes if the etiology remains unclear or the patient presents with recurrent ulcers.

• Fasting serum gastrin and secretin stimulation test

  • Measure baseline serum gastrin level and repeat after administration of secretin.

  • High levels in gastrinoma (Zollinger-Ellison syndrome)

• Serum intact PTH level

• Specific testing for systemic inflammatory diseases (e.g., Behcet disease, Crohn disease)