The tests needed to diagnose peptic ulcer disease may depend on your symptoms and on a medical history and physical exam.

If you are a younger adult who is having ulcer symptoms for the first time, your doctor may begin treatment with medicines based only on your symptoms and the results of your medical history and physical exam. But it is becoming more common to test your blood, breath, or stool immediately for Helicobacter pylori (H. pylori) infection whenever someone has common ulcer symptoms.

If you are older than 55, you may require more testing because you may be at increased risk for stomach cancer. Although the risk of stomach cancer is small, it is important to distinguish between a gastric and duodenal ulcer. If you have a stomach ulcer, it will be tested for cancer. In rare cases, stomach ulcers contain cancer cells. Further testing is needed, especially for those people older than 55 who have:

• Ulcer symptoms for the first time.
• Ulcer symptoms that return before or after treatment is completed.
• A family history of stomach cancer.
• Additional symptoms that may point to a more serious problem, such as stomach cancer. These include:
  • Blood in the stool.
  • Weight loss of more than 10% of body weight.
  • Anemia.
  • Difficulty swallowing (dysphagia).
  • Jaundice.
  • Abdominal mass.
  • Anorexia.

Tests to diagnose peptic ulcer disease

When a person has symptoms of a peptic ulcer, the following tests may be used to look for the ulcer:

• Endoscopy. Endoscopy allows the doctor to look at the inside of the stomach and upper small intestine to see whether ulcers are present. It also allows the doctor to collect a tissue sample (biopsy) that can be tested for the presence of H. pylori bacteria or other problems (such as cancer) in the stomach.
• Upper gastrointestinal (UGI) series. An X-ray exam of the esophagus and stomach (upper GI series) may be used to diagnose peptic ulcer disease, although this test is being used less frequently.

A fecal occult blood test (FOBT) may be done to detect blood in the stool, which may be caused by a peptic ulcer or another serious problem, such as colon cancer. By itself, an FOBT cannot diagnose peptic ulcer disease, but it may show if an ulcer is bleeding.

A complete blood count (CBC) also may be done to look for anemia, which may be caused by a bleeding ulcer.

Tests for H. pylori infection

Many people are infected with H. pylori bacteria, but most of them will not have symptoms of peptic ulcer disease. Because of this, the American College of Gastroenterology advises testing for H. pylori infection for people who:²

• Have active peptic ulcer disease or a past history of a peptic ulcer.
• Are known to have or have a family history of a condition called gastric mucosa-associated lymphoid tissue (MALT) lymphoma, which is a type of stomach cancer.
• Have a new case of dyspepsia, are younger than 55, and do not have bleeding, weight loss, or other symptoms that may be caused by a more serious condition.