Diagnosis and Prevention

Diagnosing Peptic Ulcer

Medical history and a physical examination are usually the preliminary check and followed by some of these diagnostic tests.

1. Laboratory test for H. pylori

Although not all peptic ulcers are caused by H. pylori bacteria, testing for H. pylori is a common procedure if patients show symptoms of peptic ulcer. There are four tests to detect H. pylori in the body  ̶  blood test, breath test, stool test and tissue test.

i) Blood test

When H. pylori bacteria invade the body, the immune system produces antibodies to fight them. A blood test checks to see if the body has made antibodies against H. pylori bacteria. This test is inexpensive but is generally inaccurate. This test could be positive even in a person with history of ulcer and had been treated for it.

ii) Breath test

A breath test checks for carbon in the breath which indicates the presence of the bacteria. For this test, patient has to drink a liquid containing radioactive carbon, which would be broken down if there were H. pylori in the body. The amount of carbon in the blood would elevate and be removed from the body as carbon dioxide when the patient exhales. A sample breath is collected by exhaling into a bag which would then sealed. If the person is infected with H. pylori, the carbon dioxide in the breath sample would contain radioactive carbon. This test is more accurate than the blood test and mostly conducted after treatment to confirm if H. pylori had been successfully eradicated.

iii) Stool test

A stool sample is collected to check for the presence of H. pylori antigens in the gastrointestinal tract. Antigens are foreign substances that induce an immune response in the body to fight the infection.  This test can be used to diagnose H. pylori infection and to determine if the treatment for the infection has been successful.

iv) Tissue test/Endoscopy

Tissue test via endoscopy is by far the most accurate test to determine H. pylori infection. This is a procedure where an endoscope – a small flexible tube with a minute camera at the end – is inserted into the body through the mouth to examine the lining of the stomach and duodenum for ulcer and for the collection of tissue sample for test. Any ulcer detected during the examination would call for a follow-up endoscopy after treatment to ensure complete healing, even if the symptoms have been relieved.

Endoscopy is highly recommended for patients older than 55 years old, have blood in the stool, experienced recent weight loss or have difficulty swallowing, as they are at a higher risk of developing stomach cancer.


2. Upper gastrointestinal series

Upper gastrointestinal series is sometimes known as barium swallow. To take this test, a patient drinks a white liquid (containing barium) which coats the digestive tract to enable a clearer detection of ulcer. This is followed by a series of X-rays of upper digestive system which generates images of the oesophagus, stomach and small intestine for the diagnosis of peptic ulcer. This is a less commonly used method of diagnosis.

Preventing Peptic Ulcer

Adopting a healthy lifestyle and habits can reduce the risk of developing a peptic ulcer.

  • Avoid infection – Wash hands frequently and consume foods that have been thoroughly cooked
  • Avoid or limit the use of NSAIDs – Take NSAIDs with food to decrease the risk of irritating stomach lining
  • Stop smoking and other tobacco use
  • Reduce stress with regular exercise and mind-body relaxation techniques such as yoga or tai chi
  • Avoid alcohol or limit to not more than two alcoholic drinks a day
  • Do not mix alcohol with medications
  • Avoid or consume caffeine in moderation
  • Maintain a healthy and balanced diet rich in fruits, vegetables and whole grains
  • Avoid eating large meals which may trigger an excessive production of gastric acid to aid digestion
  • Reduce foods that irritate stomach, e.g. citrus fruits. spicy and fatty foods
  • Reduce sodium intake or foods high in sodium, e.g. canned soup, potato chips, salted nuts, salted meats, etc
  • Increase omega-3 fatty acids in your diet by taking oily fish like salmon, mackerel, sardines and herring. These omega-3 fatty acids could increase the production of prostaglandins – a lipid that protects the lining of the whole digestive passage, including the stomach and intestines
  • Take vitamin E from foods such as hazelnuts and cold-pressed sunflower seed oil as well as zinc from seafood and whole grains.