How is dx of duodenal ulcers?

Endoscopy; however, most symptomatic cases of DU are easily diagnosed clinically. If patient responds to DU therapy, there is no need to do the biopsy. Most common location for DU: Posterior duodenal wall within 2 cm of pylorus. H. pylori: Endoscopy with biopsy—for H. pylori (organism is notoriously hard to culture—multiple specimens required during biopsy). Serology: Anti-H. pylori immunoglobulin G (IgG) indicates current or prior infection. Urease breath test: C13/14 labeled urea is ingested. If gastric urease is present, the carbon isotope can be detected as CO2 isotopes in the breath. ZE: A fasting serum gastrin level > 1,000 pg/mL is pathognomonic for gastrinoma. Secretin stimulation test: Secretin, a gastrin inhibitor, is delivered parenterally and its effect on gastrin secretion is measured. In ZE syndrome, there is a paradoxical astronomic rise in serum gastrin