Fig 1A Fig 1B

Fig 1C

Click on Images for Enlarged View

Findings: There is a smoothly marginated, abnormal barium collection that extends beyond the expected confines of the greater curvature of the stomach (Fig 1a). This abnormal collection persists on supine and prone images (Fig 1b). There is evidence of a collar of surrounding edema on the prone images (Fig 1c).

Diagnosis: Benign gastric ulcer

Discussion: Benign gastric ulcers comprise 95% of ulcers within the stomach. Underlying stress, alcohol, NSAID use and steroids are commonly described as important factors in the development of gastric ulcers. Recently the causative role of H.Pylori infection in peptic disease has been definitively established and treatment has centered on antibiotic therapy as a cornerstone in treatment.

Radiographic differentiation between benign and malignant ulcer disease is important. Classically, gastric ulcers project beyond the expected gastric lumen. Other benign features include the Hampton line, smooth ulcer collar and ulcer mound. Hampton's line is a thin, well defined lucent line at the base of the ulcer, reflecting the undermining of the submucosa with preservation of the relatively resistant mucosa. The pattern of radiating folds is also important, as the folds should be smooth and project to the ulcer mound.

The size and multiplicity of gastric ulcers have not been reliable in differentiation of benign from malignant ulcers. Greater curvature ulcers can be misleading in their appearance, as they can appear to be confined within the confines of the stomach. Radiographic healing of ulcers should occur in 3-6 weeks. If there is persistent ulceration, endoscopy is indicated.

References:
Eisenberg R. Gastrointestinal Radiology,
Lippincott, Raven, Philadelphia 1996.

Dooley CP Heliobacer Pylori Infection and Peptic Ulcer Disease.
Curr Opin Gastroenterology 1993;9:112.

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