Any dog that is vomiting frequently, and whose vomitus contains material that looks like coffee grounds, should be suspected of having gastric ulcers. A veterinarian presented with this history will conduct a thorough physical examination, including a rectal examination, and will take a comprehensive case history. She also typically will draw blood for a complete blood count and serum biochemistry panel. The initial data base usually includes a urinalysis, as well. The results of these tests will be used to assess the dog’s overall health and to check for any underlying medical conditions that could be contributing to its symptoms. They also may reveal the actual cause of stomach ulceration.
The attending veterinarian may recommend survey abdominal radiographs (X-rays), with or without the use of contrast media such as barium, as part of the initial work-up. Plain radiographs are usually not especially helpful, unless the stomach wall has actually perforated. Abdominal ultrasound can also provide valuable information about the health of the stomach and tissues of the upper gastrointestinal tract. These imaging techniques may disclose gastrointestinal obstruction by tumors or foreign materials, which might be causing or contributing to the patient’s vomiting and discomfort. Abdominocentesis, which is the sampling of free abdominal fluid, can also disclose evidence of gastric perforation. Another available diagnostic technique is peritoneal lavage.
The gold standard for diagnosing the presence of gastric ulcers in dogs is an endoscopic examination, also called a “gastroscopy”. During this procedure, the dog is sedated and a flexible endoscopic wand is passed through its mouth, down the throat (through the esophagus) and into the stomach. The wand houses a small camera at its tip, enabling the veterinarian to scan for and see signs of ulceration on a monitor screen in real-time during the examination. Superficial ulcers appear as patches of inflamed and eroded tissue, covered by whitish or yellow-ish pus. Deeper ulcers appear as crater-like lesions than in severe cases can actually penetrate full-thickness through the stomach wall. Biopsy samples of stomach tissue can also be taken with guidance from the endoscopy wand, for subsequent microscopic examination at a specialized laboratory. Most veterinarians will biopsy ulcers at their edges rather than in their center, to avoid perforating the stomach wall.
Usually, a veterinarian will be able to either rule in or rule out the presence of gastric ulcers by performing a gastroscopy. This procedure is not particularly difficult to perform, and it may help to identify the cause of stomach ulcers, if they are present. Single, isolated ulcers in an otherwise normal stomach are highly suggestive of gastric neoplasia (cancer), especially if the tissue surrounding the ulcer is thickened. Multiple ulcers or generalized ulceration suggests a different cause.