The diagnosis of peptic ulcer disease begins with a physical examination and a thorough medical and family history. The exam and history help rule out disorders that may cause similar symptoms, including gastroesophageal reflux disease (GERD), heart attack, gallstones, irritable bowel syndrome, and cancer (Ferri 2016; Lee 2013).
Upper gastrointestinal endoscopy is necessary for a conclusive diagnosis of peptic ulcer. Endoscopy allows inspection of and biopsy of the stomach and duodenal lining as well as direct culture for H. pylori. Biopsy is necessary to distinguish peptic ulcer from ulcerative malignancy. Immediate endoscopy is recommended for patients with signs of gastrointestinal bleeding, and for urgent symptoms including excessive vomiting, difficulty swallowing, and excessive weight loss (Ramakrishnan 2007; Anand 2017; DiMarino 2016a; Kuipers 2012). A complete blood count (CBC) and stool occult blood tests are recommended for patients suspected of having a bleeding ulcer (Lee 2013).
All patients with suspected peptic ulcer disease should be tested for H. pylori. Techniques that can detect H. pylori infection include blood tests to measure H. pylori antibodies, a urea breath test, and a stool antigen test (Ferri 2016; Lee 2013). Additionally, follow-up testing one to two weeks after completion of treatment should be used to confirm that H. pylori has been successfully eradicated (Chey 2017).