Gastric Ulcer Diagnosis: Risk Factors, Endoscopy with Biopsy, and H. pylori Testing for Epigastric Pain

The diagnosis of gastric ulcer is a crucial process in clinical practice, as these lesions can lead to severe complications if not treated appropriately. Gastric ulcers are lesions in the stomach mucosa that can be caused by various factors, with Helicobacter pylori (H. pylori) and NSAID use being the most common. Accurate identification of these risk factors is essential for effective disease management.

H. pylori is a common human pathogen associated with chronic gastritis, peptic ulcers, and gastric cancer. It is estimated that approximately 10% of those infected develop a peptic ulcer, and between 1-3% may develop gastric cancer [1]. On the other hand, the use of NSAIDs is a significant risk factor for peptic ulceration, acting independently or synergistically with H. pylori infection [2]. Additionally, factors such as overcrowding and family history of ulcers or gastritis have also been associated with an increased risk of H. pylori infection [3].

For the diagnosis of gastric ulcer, endoscopy with biopsy remains the standard method, allowing for direct visualization of the gastric mucosa and obtaining samples for rapid urease tests, cultures, and molecular testing [4]. However, there are also non-invasive methods such as the urea breath test and stool antigen test, which are useful for detecting H. pylori [5]. The choice of diagnostic method depends on clinical indication, pretest probability of infection, and availability of tests.

In conclusion, appropriate management of gastric ulcers requires a deep understanding of risk factors and the selection of appropriate diagnostic tests. The eradication of H. pylori is crucial to reduce disease recurrence and prevent severe complications such as gastric cancer. The combination of proton pump inhibitor-based therapies with antibiotics remains the treatment of choice, although antibiotic resistance is an increasing challenge [6]. Continuous monitoring and optimization of treatment strategies are essential to improve clinical outcomes in patients with gastric ulcers.

Referencias

[1] The Importance of Accurate Early Diagnosis and Eradication in Helicobacter pylori Infection: Pictorial Summary Review in Children and Adults

[2] Review article: Helicobacter pylori infection in peptic ulcer haemorrhage

[3] Clinical and Socio-Demographic Risk Factors for Acquisition of Helicobacter pylori Infection in Nigeria

[4] Helicobacter pylori: virulence factors, resistance and diagnosis

[5] Management of Helicobacter pylori infection in Latin America: a Delphi technique-based consensus

[6] Eradication of Helicobacter pylori in clinical situations

Created 2/1/2025