Differential Diagnosis, Complications and Diagnosis of Acid Peptic Disease
Peptic ulcer is diagnosed using blood and stool tests, breath tests, endoscopy and rarely now barium radiography. Complications include bleeding, perforation, obstruction in the digestive tract and sometimes cancer.
Differential Diagnosis or Other Possibilities:
Pain in the upper part of the abdomen is usually seen in the following conditions besides peptic ulcer disease:
- Cholecystitis (bile duct inflammation) and biliary colic
- Hepatitis or hepatic congestion
- Stomach Cancer
- Pericarditis (Inflammation of the covering of the heart)
- Pleurisy (Inflammation of the covering of the lungs)
- Myocardial infarction or heart attack
Besides having sleepless nights due to pain and other dyspeptic symptoms, bleeding, perforation, penetration into other organs and obstruction in the intestines are other complications which can develop due to chronic or acute acid peptic disorders. “Barrett’s esophagus” is a precancerous lesion which develops due to chronic GERD or “gastro esophageal reflux disorder”. GERD is a condition wherein the liquid contents of the stomach regurgitate back into the esophagus. This causes damage to the esophageal lining resulting in esophagitis and Barrett’s esophagus. Infection with H.pylori responsible for peptic ulcer disease can cause an atrophy of the stomach called “atrophic gastritis” which is a precancerous condition. Duodenal cancer is also a complication of the acid peptic disease.
Before instituting therapy, it is imperative to diagnose the ulcer disease and the H.pylori infection because treatment protocols are variable for different types of ulcer diseases. The treatment of an NSAID induced ulcer differs from the ulcer caused by H.pylori.
- Clinical History: Medical and family history establish whether ulcers are present in the family. Other information such as the misuse of NSAIDs, medicines taken and information regarding the use of alcohol, smoking and tobacco should also be elicited. Also the timing of food in relation to the pain and dyspepsia may help in the diagnosis.
- Blood Tests. Blood tests such as an enzyme-linked immunosorbent assay (ELISA) help in the measurement of antibodies to H. pylori. Serum gastrin levels should be measured in patients with multiple ulcers to consider gastrin secreting tumors or Zollinger-Ellison Syndrome. Tests for gastric secretion include the “pentagastrin test”, the “chew and spit test” and the “Hollander insulin test”.
- Stool Test. Stool test detects the presence of H. pylori in the feces and also establishes whether there is any recurrence after antibiotic therapy.
- Breath Test: The urea breath test (UBT) is helpful in the detection of H.pylori. The patient is made to drink a liquid containing carbon-labeled urea, which is broken down by the bacteria. The patient is subsequently asked to breathe into a sealed bag, which is tested for the presence of labeled carbon. A positive test indicates the presence of H pylori infection.
- Endoscopy: Endoscopy is considered a more accurate test for the diagnosis of “peptic ulcer diseases” and also helps in taking biopsy of the affected area. Gastroscopy or esophagogastroduodenoscopy (EGD) is a kind of endoscopy which is carried out on patients to detect peptic ulcer.
- Kunmam (Acid Peptic Disease) - (https://www.nhp.gov.in/Kunmam-(Acid-Peptic-Disease)_mtl)
- American College of Gastroenterology guideline on the management of Helicobacter pylori infection. - (https://www.ncbi.nlm.nih.gov/pubmed/17608775)
- The prevalence of Helicobacter pylori in acid peptic disease - (http://www.archintsurg.org/article.asp?issn=2278-9596;year=2014;volume=4;issue=2;spage=91;epage=95;aulast=Gupta )
- Long-term stress and Helicobacter pylori infection independently induce gastric mucosal lesions in C57BL/6 mice. - (https://www.ncbi.nlm.nih.gov/pubmed/12465722)
- Peptic Ulcer Disease and Helicobacter pylori infection - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140150/)
- Peptic ulcer - (http://research.omicsgroup.org/index.php/Peptic_ulcer)
- Peptic ulcers: causes, prevention, perforation and treatment - (https://pdfs.semanticscholar.org/2743/c9faddd49671362f2fe2e4d45dac181089fe.pdf)
- Peptic Ulcer: Causes and Therapy - (https://www.pharmatutor.org/articles/peptic-ulcer-causes-and-therapy?page=5%2C4)
- Peptic Ulcer: Peptic Disorders: Merck Manual Home Edition.
- Chey WD, Wong BC. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. Aug 2007;102(8):1808-25.
- Kato, Ikuko; Abraham M. Y. Nomura, Grant N. Stemmermann and Po-Huang Chyou (1992). "A Prospective Study of Gastric and Duodenal Ulcer and Its Relation to Smoking, Alcohol, and Diet". American Journal of Epidemiology 135 (5): 521–530. PMID 1570818.
- Malagelada JR, Kuipers EJ, Blaser MJ. Acid peptic disease: clinical manifestations, diagnosis, treatment, and prognosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 142.
- Kim YH, Lee JH, Lee SS, et al. (2002). "Long-term stress and Helicobacter pylori infection independently induce gastric mucosal lesions in C57BL/6 mice". Scand. J. Gastroenterol. 37 (11): 1259–64. doi:10.1080/003655202761020515. PMID 12465722.