Gastric ulcers are disruptions of the mucosa that extend into or through the submucosa. The radiologic imaging study of choice in the clinical evaluation of suspected gastric ulcers is a double-contrast upper GI series. Features to evaluate include location, shape, penetration, mucosal folds, and the ulcer mound. Ulcers are generally classified as either benign or malignant depending upon their radiographic features and underlying etiology.

Benign Ulcers

Benign ulcers constitute approximately 95% of all gastric ulcers. Factors contributing to ulcer formation include h. pylori infection, tobacco use, alcohol consumption, drugs (i.e. NSAIDs and corticosteroids), and severe physical stress, such as surgery, shock, burns, or trauma. Despite the numerous etiologies, all benign ulcers share the common pathophysiology of a disrupted mucosal barrier in the presence of increased acid production, and are collectively referred to as peptic ulcer disease . Males and females are equally affected. Patients present with epigastric abdominal pain that is frequently postprandial and worse at night. Bleeding secondary to vessel involvement is the most common complication.

Acid reduction via H2 receptor blockers and proton pump inhibitors is the therapeutic mainstay. Most benign ulcers heal in 3-4 weeks following treatment with complete resolution by 6 weeks. All gastric ulcers should be followed by repeat examination in 6 weeks to confirm healing. Surgery is rarely performed for benign gastric ulcers but may be indicated if outlet obstruction occurs.

Radiographic Findings: UGIS

• Location: Most commonly occur on the lesser curvature or posterior wall of the stomach within or near the antrum

• Shape: Ulcer crater is smooth and round or oval

• Penetration: The ulcer projects beyond the normal margin of the gastric lumen

• Mucosal Folds: Extension of smooth gastric folds to the ulcer crater margin

• Ulcer Collar: An edematous mucosal band across the ulcer neck

• Hampton 's Line: A thin mucosal line across the ulcer neck due to ulcer extension into the submucosa