Contemporary diagnosis: endoscopy and imaging in peptic ulcer disease

Upper gastrointestinal endoscopy is considered the gold standard for the diagnosis of peptic ulcer disease because, in addition to directly visualizing ulcers, it also allows for biopsies and the treatment of complications. Diagnosis and treatment of Helicobacter pylori are fundamental in peptic ulcer disease. For H. pylori diagnosis, there are non-invasive methods used in patients with dyspeptic symptoms without alarm symptoms, and invasive tests that require endoscopy for sample collection. The indication for endoscopy varies according to the clinical scenario. In the context of gastrointestinal bleeding, early endoscopy is recommended, allowing for treatment based on endoscopic findings (Forrest classification). When there is persistent vomiting and peptic stricture is suspected, endoscopy is also recommended. In dyspepsia, international guidelines recommend testing for H. pylori and treating if positive. Endoscopy is only recommended in individuals over a certain age, in cases of red flags, or when symptoms persist despite treatment. Computed tomography is the study of choice when a perforated peptic ulcer is suspected. In patients with abdominal pain in whom an acute abdomen has been ruled out, there are some tomographic features that may suggest a peptic ulcer. Some studies suggest that capsule endoscopy may be useful for risk stratification in patients with upper gastrointestinal bleeding.