Investigations

National Institute for Health and Care Excellence (NICE) guidelines state that endoscopy is not required unless the patient is presenting for the first time above the age of 55, or there are these warning signs;

• Iron-deficiency anaemia
• Chronic blood loss
• Weight loss
• Progressive dysphagia
• Persistent vomiting
• An epigastric mass

• a suspected gastric ulcer may be a malignancy and should always be biopsied. If the lesion is identified on a barium meal then biopsies must follow. A further endoscopy must occur after treatment to ensure healing. Most benign gastric ulcers occur on the lesser curve of the stomach or in the pre-pyloric region.
• duodenal ulceration is almost never the site of malignancy and therefore it usually not necessary to undertake biopsies. In this case, diagnosis can be be made on barium meal or endoscopy. A follow-up endoscopy to ensure healing after treatment if the patient has become asymptomatic is generally not required.
• gastrin levels are helpful if Zollinger-Ellison syndrome is suspected (if H. pylori is negative, or has been eradicated and ulceration is refractory/recurrent)
• acid-output studies are not often required
• H pylori infection status will normally have been confirmed during the index endoscopy for diagnosis of peptic ulcer, via biopsy samples taken for rapid urease testing or histology.

Reference:

1. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. NICE Clinical Guideline (Sept 2014 - last updated October 2019)