In a patient with gastritis presenting with hematemesis, which test is most sensitive for diagnosing the condition?

• A. Upper Endoscopy
• B. Hemoccult Test
• C. Esophageal Manometry
• D. Urea Breath Test

Answer: (A)

When you suspect gastritis presenting with hematemesis, the most sensitive and informative test is upper endoscopy. It allows direct visualization of the gastric mucosa to confirm inflammation, erosions, or ulcers, and it precisely locates the bleeding source. In addition, it enables biopsies to assess inflammation and test for Helicobacter pylori, which helps establish etiology and guide treatment.

Tests like the Hemoccult detect blood in stool, which isn’t helpful for diagnosing acute gastritis. Esophageal manometry measures esophageal pressures and motility, not gastric mucosa. The urea breath test detects H. pylori infection but does not diagnose gastritis itself, and its accuracy can be compromised during active bleeding or recent acid-suppressive therapy, making it less useful in the acute management setting.