The questioning of the patient according to the history of the disease (history) is at the beginning of each examination - even if there is a suspicion of an ulcer. The history can only give evidence of an ulcer, no security, as there are no specific complaints. The focus is therefore on the question of previous (endoscopically confirmed) Ulkusschüben and their therapy, possibly after the composition of previously taken antibiotic combinations to combat Helicobacter pylori.
Anamnesis as part of the diagnosis
When questioning the patient, information on the duration of a possible tarry stool and possibly the accompanying vomiting of blood is particularly important. Alcohol, analgesics, cortisone, and nicotine in prehistory play a crucial role, as these substances attack the gastric protective layer and thus promote the development of gastric ulcers.
Physical examination for suspected ulcer
After the anamnesis the detailed physical examination takes place. The palpation of the abdomen is inconspicuous in most cases due to the relatively mild discomfort. With particularly pronounced gastritis and gastric ulcers present at the same time, pressure pain can occur in the pit of the stomach. An ulcer perforation, on the other hand, can lead to tension on the abdominal wall, even to the chest-hard abdomen, or cause ileal symptoms (intestinal paralysis) with missing bowel sounds.
Signs of anemia such as lack of concentration, rapid fatigue, and pale skin color may indicate repeated minor blood loss from the upper gastrointestinal tract.
Reflection of the esophagus, stomach and small intestine
Finally, for the presence of a gastric or duodenal ulcer, esophageal gastro-duodenoscopy (esophageal, gastric and small bowel obstruction) is evidence. The examination of the stomach and small intestine with the removal of a tissue sample is the method of choice for the examination of this part of the digestive tract. Since an ulcer can also conceal a malignant degeneration (gastric cancer), the extracted tissue sample is examined microscopically for tumor cells.
Bleeding from the upper gastrointestinal tract can lead to a life-threatening situation, so mirroring is an indispensable method of examination. Not only the mucous membranes of the individual organs can be examined, but bleeding can be stopped, for example by injecting. In this procedure, adrenaline (stress hormone of the adrenal gland) is injected into the source of bleeding, thereby narrowing the vessel so much that the bleeding stops. In addition, a rapid urease test is performed to determine if Helicobacter pylori infection is responsible for gastric ulcer.
Determine bleeding activity
The bleeding activity of a gastric ulcer is made after a certain division (Forrest). Thus, a type Ia ulcer is an acute splashing hemorrhage, while type Ib bleeding only seeps. In IIa ulcer the vascular stump is visible, but not bleeding. An IIb ulcer is covered with a blood clot, and the Type III ulcer is already in the healing phase.
X-ray not mandatory
An X-ray overview is only required if the ulcer destroys the stomach wall to the extent that a wall opening into the abdominal cavity and an acute abdomen (acute abdomen) is suspected. The determination of the blood picture (white, red blood cells, blood coloring) is necessary, in order to prove possible anemia. Anemia can be the result of bleeding of the gastric mucosa.
The prognosis of peptic ulcer is favorable. In Germany, 6 out of every 100, 000 people die from gastric ulcer, 4 out of every 100, 000 from a duodenal ulcer. Fatal complications mainly affect patients over 70 years old, men are twice as likely as women.