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.
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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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