Diagnosis for Duodenal Ulcer
The diagnosis of an ulcer is made by either a barium upper GI X-ray or an upper endoscopy (EGD – esophagogastroduodenoscopy).  The barium upper GI X-ray is easy to perform and involves no risk or discomfort.  Barium is a chalky substance administered orally.  Barium is visible in X-rays, and outlines the stomach on X-ray film.  However, barium X-rays are less accurate and may not detect ulcers up to 20% of the time.

An upper endoscopy is more accurate, but involves sedation of the patient and the insertion of a flexible tube through the mouth to inspect the stomach, esophagus, and duodenum.  Upper endoscopy has the added advantage of having the capability of removing small tissue samples (biopsies) to test for H.  pylori infection.  Biopsies can also be examined under a microscope to exclude cancer.  While virtually all duodenal ulcers are benign, gastric ulcers can occasionally be cancerous and for this reason biopsies are often performed.