What is the preferred test for the diagnosis of peptic ulcer disease (PUD)?

Updated: Apr 26, 2021
  • Author: BS Anand, MD; Chief Editor: Philip O Katz, MD, FACP, FACG  more...
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Answer

The American Society for Gastrointestinal Endoscopy (ASGE) released guidelines for sedation and anesthesia in gastrointestinal endoscopy in January 2018. [34] (See ASGE Guidelines.)

Upper gastrointestinal (GI) endoscopy is the preferred diagnostic test in the evaluation of patients with suspected peptic ulcer disease. It is highly sensitive for the diagnosis of gastric and duodenal ulcers, allows for biopsies and cytologic brushings in the setting of a gastric ulcer to differentiate a benign ulcer from a malignant lesion, and allows for the detection of H pylori infection with antral biopsies for a rapid urease test and/or histopathology in patients with peptic ulcer disease. (See the images below.)

At endoscopy, gastric ulcers appear as discrete mucosal lesions with a punched-out smooth ulcer base, which often is filled with whitish fibrinoid exudate. Ulcers tend to be solitary and well circumscribed and usually are 0.5-2.5 cm in diameter. Most gastric ulcers tend to occur at the junction of the fundus and antrum, along the lesser curvature. Benign ulcers tend to have a smooth, regular, rounded edge with a flat smooth base and surrounding mucosa that shows radiating folds. Malignant ulcers usually have irregular heaped-up or overhanging margins. The ulcerated mass often protrudes into the lumen, and the folds surrounding the ulcer crater are often nodular and irregular.

Peptic ulcer disease. Gastric ulcer with a punched Peptic ulcer disease. Gastric ulcer with a punched-out ulcer base and whitish fibrinoid exudates.
Peptic ulcer disease. Gastric ulcer (lesser curvat Peptic ulcer disease. Gastric ulcer (lesser curvature) with a punched-out ulcer base with a whitish exudate.
Peptic ulcer disease. Gastric cancer. Note the irr Peptic ulcer disease. Gastric cancer. Note the irregular heaped-up overhanging margins.
Peptic ulcer disease. Gastric cancer with an ulcer Peptic ulcer disease. Gastric cancer with an ulcerated mass.

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