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I had a stomach endoscope as part of my general health check. They weren't told to check for a peptic ulcer but I'd assume given my symptoms of gas they would have looked for it. It came back with no concerns- could have seen it directly if I had really wanted to. Can a stomach endoscope check miss a peptic ulcer?

  • Well, a human is involved, so there’s always the potential of a mistake. I’d say it’s quite unlikely though. – Narusan Sep 30 '17 at 14:47
  • Assuming the doctor did it perfectly can it still be missed i.e. is there any error with the test itself. – user2617804 Oct 1 '17 at 3:31
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    No. There really isn't anything to the test other than the doctor's eyeballs, so if they miss it, the doctor failed. If the endoscope itself failed, that would be obvious to the doctor and they would have to repeat the exam. – Carey Gregory Oct 1 '17 at 23:20
  • It uses an endscope which has limits and the symptoms have to visually detectable. – user2617804 Oct 2 '17 at 7:49
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    A typical symptom of a peptic ulcer is epigastric pain and not gas (flatulence). In an ulcer caused by H. pylori bacteria, the additional symptoms could be nausea and excessive belching. The most common cause of gas is probably eating a lot of foods high in soluble fiber (legumes, oats, barley...) or polyols, such as sorbitol (in some sodas, chewing gum...). Other common causes are lactose intolerance, fructose malabsorption, celiac disease and intestinal parasites. There are tests available for each of them. Additionally, the irritable bowel syndrome can cause a feeling of bloating. – Jan Oct 4 '17 at 14:13
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An EGD (esophagogastroduodenoscopy) with biopsy has a sensitivity of 95% for diagnosing Peptic Ulcers. That means less than 5% are missed. Remember, this is on average.

That doesn't sound amazing, but it's actually pretty good. This article talks about clinical predictors for ulcers, which are also very important in diagnosis. If someone has symptoms, the threshold for suspicion goes up. A good history and physical exam will let the doctor know how much to suspect an ulcer. That is called a pre-test probability.

NO ulcer signs/symptoms + negative EGD = likelihood of having an ulcer is extremely low.

MANY ulcer signs/symptoms + negative EGD = still low, but worth a discussion. There may be another test (like pH, urease, etc) that could increase diagnostic accuracy IN SOME CASES.

But you say it like it was done as a routine screening part of your "general health check," which is strange. We generally don't just throw EGDs at every human with a stomach, we do them when there is high enough suspicion that something is wrong. So make sure you have the conversation with your doctor so he/she can help you understand both the reason for doing the test AND the results.

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