Peptic ulcer disease (summary)

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This is a basic article for medical students and other non-radiologists

Peptic ulcer disease encompasses a number of entities that are the result of gastric mucosal ulceration secondary to the effects of gastric acid. Since the recognition of Helicobacter pylori as a common causative agent and the development of powerful anti-acid medications, peptic ulcer disease has become comparatively rare in western populations.

Reference article

This is a summary article; read more in our article on peptic ulcer disease.

Summary

  • anatomy
  • epidemiology
    • older population with M:F ratio of 3:1
    • main risk factors
      • H. pylori
      • NSAID and corticosteroid use
      • severe physical stress
  • presentation
    • dyspeptic symptoms
    • hemorrhage (14%)
      • incidental (fecal-occult blood)
      • acute (melena, hematemesis, or both)
    • perforation (6%)
    • gastric-outlet obstruction (rare)
  • pathophysiology
    • mucosal ulceration secondary to gastric acid
  • investigation
    • endoscopy if the test of choice to confirm ulceration and biopsy
    • radiology of limited use
    • hemorrhage is challenging to detect even with multi-phase CT
  • treatment
    • dyspepsia: anti-acid medication
    • hemorrhage: treat the source, e.g. vasoconstrictor injection
    • perforation: surgery

Role of imaging

There is limited use of imaging in the dyspeptic patient.

Radiographic features

CT

In the acute setting, patients may have a CT abdomen if they present with pain and perforation is not difficult to identify. In a patient with GI hemorrhage, even with multiphase contrast-enhanced CT, hemorrhage is challenging to identify.

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