Diagnosis Documentation – radiographic (barium study) – endoscopic procedure Empirical therapy before diagnostic evaluation – individuals who are otherwise healthy and <45

Diagnosis Barium studies – proximal gastrointestinal tract: first test for documenting an ulcer – single-contrast barium meals sensitivity: as high as 80% – double-contrast study: detection rates as high as 90% – Sensitivity decreased in: small ulcers (<0.5 cm), presence of previous scarring, or in postoperative patients

Diagnosis Barium studies – Duodenal Ulcer: well-demarcated crater, most often seen in the bulb – Gastric Ulcer: benign or malignant disease Benign GU: discrete crater with radiating mucosal folds originating from the ulcer margin Malignant GU: Ulcers >3 cm in size or those associated with a mass – up to 8% of GUs that appear to be benign by radiographic appearance are malignant by endoscopy or surgery – Radiographic studies that show a GU must be followed by endoscopy and biopsy

Diagnosis Endoscopy – most sensitive and specific approach for examining the upper gastrointestinal tract – direct visualization of the mucosa – photographic documentation of a mucosal defect and tissue biopsy to rule out malignancy (GU) or H. Pylori – identifying lesions too small; for evaluation of atypical radiographic abnormalities; determine if an ulcer is a source of blood loss

Diagnosis Endoscopy – clean-based ulcer is associated with a low 3–5% risk of rebleeding – Flat red or purple spots in the ulcer base and large adherent clots covering the ulcer base have a 10 and 20% risk of rebleeding – Endoscopic therapy is often considered for an ulcer with an adherent clot – platelet plug: the risk of rebleeding from the ulcer is 40%