Gastric ulcer evaluation (barium)

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Gastric (peptic) ulcers can be detected on multiple imaging modalities, but are best evaluated on a double-contrast barium upper GI study. This article discusses their appearance on a double contrast study, for a more complete description, see the full article on peptic ulcers.

Radiographic features

Appearance

The classic appearance for a benign gastric ulcer on a double-contrast study is

>2 mm oval mucosal defect (a "crater")
thin gastric folds radiating toward the crater

There are however, multiple different appearances that an ulcer may take, including a linear shape or a serpentine shape. Mucosal defects <2 mm are termed "erosions".

Ulcers are often associated with a ring of edema around the ulcer crater, which can give rise to a thin radiolucent "waist" to the ulcer crater. This has been termed a Hampton line, ulcer collar, or ulcer mound, as increasing amounts of edema are present.

Ulcer location

The vast majority (90-95%) of gastric ulcers are located on the lesser curvature and posterior stomach wall in the gastric body and antrum. They are uncommonly seen on the greater curvature (~5%).