Peptic Ulcer - Diagnosis and Treatment

Diagnosis

Doctors start with a few steps to figure out if someone has a peptic ulcer—this could mean a gastric ulcer, a duodenal ulcer, or sometimes even an esophageal ulcer.

Usually, they begin by taking a thorough medical history and doing a physical exam. They’ll ask about symptoms like burning pain, nausea, vomiting, heartburn, weight loss, or signs of bleeding, such as bloody stool.

If you have certain “alarm symptoms” like sudden weight loss, trouble swallowing, or vomiting blood, it can mean something more serious is going on—maybe even a risk of gastric cancer, a perforation, or a blockage.

Key tests doctors use to diagnose peptic ulcer disease:

Laboratory Checks for H. pylori:
- Breath Test: You drink or eat a special solution, and if H. pylori is there, your breath shows a chemical change.
- Stool Antigen Test: Looks for signs of H. pylori in your stool.
- Blood Test: Checks if your immune system has responded to H. pylori.
Endoscopy (Upper Endoscopy/Esophagogastroduodenoscopy): The doctor uses a slim tube with a tiny camera to look inside your esophagus, stomach, and duodenum for ulcers, bleeding, or erosions.
- Biopsy: During endoscopy, they might take a small piece of tissue to check for H. pylori, rule out cancer, or spot other changes in your stomach lining.
Upper GI Series (Barium Swallow): You swallow a barium liquid that coats your digestive tract. This helps the doctor see ulcers or blockages on X-rays.

Common ulcer symptoms that usually lead doctors to order these tests:

Symptom	Common in Ulcers
Abdominal pain	Yes
Burning pain	Yes
Nausea or vomiting	Yes
Bloody stool	Sometimes
Weight loss	Sometimes
Heartburn	Often

Sometimes, if the cause isn’t clear—like if doctors suspect Zollinger-Ellison syndrome—they’ll order extra tests.

Finding the problem early can help prevent big complications like bleeding, perforation, or a blockage, and it makes it easier to choose the right treatment.

Options for Peptic Ulcer Care

Treating a peptic ulcer means getting rid of the cause, healing the sore, and stopping it from coming back.

Doctors usually use antibiotics, acid suppression, and medicines that protect the stomach lining.

Some folks need to stop certain medications or tweak their habits to help everything heal up.

Checking Progress After Ulcer Therapy

After treatment, most ulcers start to heal up. Doctors like to schedule regular follow-ups to make sure things are improving.

If you’re still dealing with symptoms or had a pretty severe ulcer, your doctor might suggest another endoscopy. This lets them look inside and see if the ulcer’s actually healing.

If they saw an ulcer during your first endoscopy, they might do a second one after treatment. That extra check makes sure the sore is gone and nothing else is causing your symptoms.

Common Assessments After Treatment:

Test	Purpose	When Used
Endoscopy	To view and confirm healing	After symptoms or severe cases
H. pylori Test	To check for remaining infection	After antibiotic therapy
Medical Review	To check medications and healing progress	At follow-up appointments

Doctors often review your medications and lifestyle habits, too. They might suggest quitting smoking or changing anti-inflammatory drugs to help keep ulcers from returning.

When the Ulcer Does Not Heal

Some ulcers just don’t heal as expected—these are called refractory ulcers. This can happen for a few reasons. Maybe the medicine wasn’t taken exactly as prescribed.

Sometimes, H. pylori bacteria resist antibiotics. If someone keeps taking NSAIDs like ibuprofen or aspirin, healing can slow down.

Rarely, the stomach might make too much acid (like with Zollinger-Ellison syndrome), or there could be other issues like infections, cancer, or illnesses such as Crohn’s disease.

What doctors do for hard-to-heal ulcers:

Find and Remove Barriers: Doctors check if you’re using NSAIDs or smoking, since both slow healing. They’ll probably recommend quitting or changing these habits.
Try Different Medicines: If H. pylori resists treatment, doctors might try other antibiotics or a new combination.
Manage Complications: If there’s serious bleeding or a hole in the stomach, you might need hospital care, special endoscopic procedures, or, in rare cases, surgery.

Types of Medications Used:

Antibiotics: Go after H. pylori.
Proton Pump Inhibitors (PPIs): Lower acid to help healing.
Acid Blockers (H2 Blockers): Bring down stomach acid and help with pain.
Antacids: Give quick relief, but don’t actually heal the ulcer.
Protective Agents: These agents help shield the stomach lining.

Here’s a quick table for reference:

Medicine Type	Main Role
Antibiotics	Kill H. pylori
PPIs	Suppress stomach acid
H2 Blockers	Block acid and relieve pain
Antacids	Relieve pain fast
Protective Agents	Protect stomach/intestinal lining

Doctors rarely use surgery these days because medicines usually work well. Most people don’t need an operation anymore.

Everyday Habits and Home Tips

Changing a few habits can really help manage stomach ulcer symptoms. Avoiding smoking is important—it damages the stomach lining and ramps up acid production.

Cutting back or quitting alcohol can also protect your digestive tract and help prevent irritation.

If you use NSAIDs or aspirin for pain, talk to your healthcare provider about safer options like acetaminophen. This switch can help protect your stomach.

Keeping stress under control also makes a difference. Try walking, hanging out with friends, meditating, or even journaling—these things can lower stress and ease discomfort.

Step	Why It Helps
Stop smoking	Reduces stomach lining damage and acid
Limit alcohol	Prevents irritation and bleeding
Choose safer pain relief	Lowers risk of ulcers from certain painkillers
Manage stress	Eases symptoms and supports healing

These simple steps support digestive health and help prevent new or worse ulcers.

Other Treatments

Bismuth-based products can relieve stomach ulcer symptoms. Some studies say zinc might help healing, too.

But before starting any new remedy or supplement—even these—talk to your healthcare provider.

Getting Ready for Your Visit

Steps to Take Before Your Appointment

Before you see your healthcare provider, it helps to organize your health info. Ask if there are any special rules before your visit, like stopping certain medicines or skipping certain foods.

Bring a list of your symptoms—when they started, and if they change when your stomach is empty.

It also helps to note:

Current symptoms
Medical history and any recent stresses or big changes
Family history of ulcers or digestive issues
All medications, vitamins, and supplements, including pain relievers and how often you take them

Writing down questions ahead of time can make your appointment more productive.

Some good questions might be:

Question	Purpose
What could be causing my symptoms?	Understand possible sources of discomfort
What tests will I need?	Learn about needed checks or procedures
Will I need changes to my diet?	Find out if any foods should be avoided
What treatments are available?	Explore options for managing the condition
How should other health problems be handled together with this one?	Coordination of care

Questions the Healthcare Provider May Ask

At your appointment, your provider will ask questions like:

How often do symptoms show up, and do they come and go?
How severe is the discomfort?
Are symptoms worse when your stomach is empty or at other times?
What makes the symptoms better or worse?
Is there nausea or vomiting?
Have you noticed blood in vomit or stool, or are your stools dark?

These questions help your provider get a better sense of what’s going on.

Steps to Manage Symptoms Before the Visit

If you’re waiting for your appointment, you might wonder what you can do in the meantime. Try to avoid tobacco, alcohol, and spicy foods—these can make symptoms worse.

Stick to mild, non-irritating foods to help ease discomfort until your visit.

Peptic Ulcer – Diagnosis and Treatment