Imaging

Peptic Ulcer Disease

Preliminary Diagnosis: Peptic Ulcer Disease

I. What imaging technique is first-line for this diagnosis?

  • Fluoroscopic upper GI series

II. Describe the advantages and disadvantages of this technique for diagnosis of peptic ulcer disease.

Advantages

  • Diagnostic in advanced cases of peptic ulcer disease when ulcers are usually greater than 1cm

  • Imaging features can aid in determining benign and malignant ulcer disease

  • Real time fluoroscopy can also evaluate motility of the esophagus and stomach

  • Imaging can be repeated after medical therapy in 8 weeks to evaluate for resolution. If not resolved, malignant gastric ulcer is not excluded.

Disadvantages

  • Requires patient cooperation

  • Small ulcers may be missed

  • Pathology external to the lumen cannot be identified

  • Exposure to ionizing radiation

III. What are the contraindications for the first-line imaging technique?

  • Active complications from peptic ulcer disease such as perforation or bleeding

  • Not recommended in early pregnancy

IV. What alternative imaging techniques are available?

  • Computed tomography with water soluble oral contrast

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of peptic ulcer disease.

Computed tomography with water soluble oral contrast

Advantages

  • Can readily show complications of ulcer disease such as wall thickening, free air, extravasation of contrast

  • Requires less patient cooperation

  • Relatively fast

Disadvantages

  • The ulcer itself may not be identified

  • Exposure to ionizing radiation

VI. What are the contraindications for the alternative imaging techniques?

Computed tomography with water soluble oral contrast

  • CT is not recommended in early pregnancy

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