The most appropriate methods for diagnosing peptic ulcers include endoscopy and testing for Helicobacter pylori infection.
Endoscopy is used to directly visualize the gastric or duodenal mucosa and confirm the presence of ulcers, especially in cases of severe or complicated symptoms, or when malignancy needs to be excluded. Repeat endoscopy is recommended 6 to 8 weeks after treatment initiation for gastric ulcers to assess healing and exclude malignancy depending on lesion size NICE CG184.
Testing for Helicobacter pylori is essential as it is a major cause of peptic ulcers. Recommended tests include the carbon-13 urea breath test or stool antigen test, with laboratory-based serology only if locally validated. Testing should be done after a 2-week washout period from proton pump inhibitors (PPIs) to avoid false negatives NICE CG184.
Serological tests performed in office settings are not recommended due to inadequate performance NICE CG184.
In summary, diagnosis involves endoscopic confirmation of ulcers and non-invasive testing for H. pylori infection to guide eradication therapy NICE CG184.