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Diagnosis of peptic ulcer disease
Last reviewed: 06.07.2025
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When collecting anamnesis, it is necessary to pay attention to the heredity burdened with gastroduodenal pathology, dietary habits, bad habits and concomitant diseases, the range of medications used.
Physical examination
Examination, palpation, percussion, auscultation are carried out using traditional methods. In addition to the data obtained, the diagnosis is based on the results of instrumental, morphological and laboratory research methods, including esophagogastroduodenoscopy, pH-metry and diagnostics of H. pylori infection.
Laboratory research
Mandatory laboratory tests: clinical analysis of blood, urine and feces, fecal occult blood test, biochemical blood test (concentration of total protein, albumin, cholesterol, glucose, amylase, bilirubin, iron, transaminase activity).
The diagnostic algorithm for H. pylori infection in children with duodenal ulcer disease corresponds to that for gastroduodenal pathology and is described in these articles:
- Helicobacter pylori infection: Helicobacter pylori detection
- 13c urease test: preparation, results, positive, negative
- Helicobacter pylori breath test: how to prepare, how it is performed, interpretation, norm.
Given the variety of clinical symptoms of duodenal ulcer, the main method in diagnosing the disease is considered to be esophagogastroduodenoscopy, which allows not only to detect ulcerative-inflammatory changes in the gastrointestinal mucosa, but also to track the dynamics of the ulcer process, diagnose complications, and determine the nature of motor-evacuation disorders. In addition, during esophagogastroduodenoscopy, it is possible to perform a targeted biopsy of the gastrointestinal mucosa under visual control to conduct a morphological study of the biopsy and diagnose microflora contamination, including H. pylori. Morphological examination allows to clarify the features of the course of peptic ulcer disease, according to some scientists, it plays the role of the main method for determining the activity of the inflammatory process.
Instrumental research methods
Ultrasound of the abdominal organs in peptic ulcer disease is indicated for the diagnosis of concomitant pathology of the hepatobiliary system and pancreas.
The X-ray method is used primarily to search for complications of the ulcer process (scarring deformation of organs, stenosis, convergence of folds, motor-evacuation disorders of the gastroduodenal zone). Detection of an ulcer niche serves as a direct sign of the disease and allows determining the localization, size, and depth of the ulcer defect. In children, the use of X-ray methods is limited by high radiation exposure and a comparatively lower diagnostic value of these methods.
To assess the state of gastric secretion, probe and non-probe methods are used.
Fractional sounding allows to reliably evaluate the secretory, acid- and enzyme-forming functions of the stomach. The study is carried out in 3 phases of the secretory cycle: fasting, basal (interdigestive) and stimulated (digestive). Various pharmacological drugs (histamine, pentagastrin) are used as stimulants. At the same time, the method does not allow to evaluate pH in real time, to determine the parameter in isolation in a particular section of the stomach, in the esophagus or duodenum, which reduces the diagnostic value of fractional sounding.
Daily pH monitoring is performed using the following devices: a compact portable recording unit, a pH-metric probe with a cutaneous silver chloride reference electrode, and a computer with software. Daily pH monitoring makes it possible to study the acid-producing function of the stomach under conditions as close as possible to physiological ones, to study the effect of various endogenous and exogenous factors, including medications, on acid production, and to accurately record duodenogastric and gastroesophageal refluxes. This technique allows not only to determine the rhythm of gastric secretion, but also to individually select a dose of antisecretory drugs under the control of the pH level. Daily pH-metry is preferably performed twice: the first time without prescribing medications, and the second time - during treatment to assess the effectiveness of the correction.
Indications for consultation with other specialists
All patients are advised to consult a dentist, otolaryngologist, hematologist - if there are signs of gastrointestinal bleeding or anemia, a surgeon - if there is severe pain syndrome and the possibility of complications.
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