Question

Please describe how Peptic Ulcer is diagnosed (scan, tests, procedures, etc.) treatments or procedures, and medical specialists may be involved?

Answer 1

Peptic ulcer disease (PUD) is a break in the inner lining of the stomach, first part of the small intestine or sometimes the lower esophagus. Peptic ulcer is diagnosed with the help of medical history, a physical exam, and tests. he presence of an ulcer can only be determined by looking directly at the stomach with endoscopy or an X-ray test.

• Medical history

To help diagnose a peptic ulcer, the doctor will ask questions about patients medical history, symptoms, and the medicines they take.

• Physical Exam

A physical exam may help a doctor diagnose a peptic ulcer. During a physical exam, a doctor most often checks for bloating in abdomen, listens to sounds within the abdomen using a stethoscope, taps on abdomen checking for tenderness or pain.

• Laboratory tests for H. pylori.

1.Blood test.

2. Urea breath test:

For a urea breath test, patient will drink a special liquid that contains urea, a waste product that body makes as it breaks down protein. If H. pylori are present, the bacteria will change this waste product into carbon dioxid(a harmless gas). Carbon dioxide normally appears in our breath when we exhale.

A health care professional will take a sample of patients breath by having you breathe into a bag at a lab. If breath sample has higher levels of carbon dioxide than normal, patient have H. pylori in his stomach or small intestine.

3. Stool test:

Doctors use a stool test to study a sample of patients stool and send for analysis to detect the presence of H. pylori.

4. Upper gastrointestinal (GI) endoscopy and biopsy:

In an upper GI endoscopy, a gastroenterologist, surgeon, or other trained health care professional uses an endoscope to see inside the upper GI tract. This procedure takes place at a hospital or an outpatient center.

An intravenous (IV) needle will be placed in the arm to provide a sedative. Sedatives help patient to stay relaxed and comfortable during the procedure. In some cases, the procedure can be performed without sedation. A liquid anesthetic will be given to gargle or spray anesthetic on the back of the throat. The doctor will carefully feed the endoscope down esophagus and into the stomach and duodenum. A small camera mounted on the endoscope sends a video image to a monitor, allowing close examination of the lining of the upper GI tract. The endoscope pumps air into the stomach and duodenum, making them easier to see.

The doctor may perform a biopsy with the endoscope by taking a small piece of tissue from the lining of the patient's esophagus. A pathologist examines the tissue in a lab.

5. Upper GI series:

An upper GI series looks at the shape of your upper GI tract. An x-ray technician performs this test at a hospital or an outpatient center. A radiologist reads and reports on the x-ray images. During the procedure, the patient will stand or sit in front of an x-ray machine and drink barium, a chalky liquid. Barium coats the esophagus, stomach, and small intestine so that the doctor can see the shapes of these organs more clearly on x-rays.

6. Computerized tomography (CT) scan:

A CT scan uses a combination of x-rays and computer technology to create images. For a CT scan, a health care professional may give a solution to drink and an injection of a special dye or contrast medium. The patient has to lie on a table that slides into a tunnel-shaped device that takes the x-rays. An x-ray technician performs the procedure in an outpatient center or a hospital, and a radiologist interprets the images. CT scans can help diagnose a peptic ulcer that has created a hole in the wall of the stomach or small intestine.

Treatment

Treatment for peptic ulcers depends on the cause. Usually treatment will involve killing the H. pylori bacterium, if present, eliminating or reducing use of NSAIDs, if possible, and helping ulcer to heal with medication.

Medications can include:

• Antibiotic medications to kill H. pylori:

If H. pylori is found in digestive tract, doctor may recommend a combination of antibiotics to kill the bacterium. These may include amoxicillin (Amoxil), clarithromycin (Biaxin), metronidazole (Flagyl), tinidazole (Tindamax), tetracycline (Tetracycline HCL) and levofloxacin (Levaquin).

Patient needs to take antibiotics for two weeks, as well as additional medications to reduce stomach acid, including a proton pump inhibitor and possibly bismuth subsalicylate (Pepto-Bismol).

• Medications that block acid production and promote healing:

Proton pump inhibitors also called PPIs reduce stomach acid by blocking the action of the parts of cells that produce acid. These drugs include the prescription and over-the-counter medications omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), esomeprazole (Nexium) and pantoprazole (Protonix). Long-term use of proton pump inhibitors, particularly at high doses, may increase risk of hip, wrist and spine fracture.

• Medications to reduce acid production:

Acid blockers also called histamine (H-2) blockers reduce the amount of stomach acid released into digestive tract, which relieves ulcer pain and encourages healing.

Available by prescription or over-the-counter, acid blockers include the medications ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet HB) and nizatidine (Axid AR).

• Antacids that neutralize stomach acid.

Doctor may include an antacid in the drug regimen. Antacids neutralize existing stomach acid and can provide rapid pain relief. Side effects can include constipation or diarrhea, depending on the main ingredients. Antacids can provide symptom relief, but generally aren't used to heal the ulcer.

Medications that protect the lining of your stomach and small intestine. In some cases, doctor may prescribe medications called cytoprotective agents that help protect the tissues that line stomach and small intestine. Options include the prescription medications sucralfate (Carafate) and misoprostol (Cytotec).