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Laucirica I, García Iglesias P, Calvet X. [Peptic ulcer]. Med Clin (Barc) 2023; 161:260-266. [PMID: 37365037 DOI: 10.1016/j.medcli.2023.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/28/2023]
Abstract
Peptic ulcer disease is a frequent pathology; although the incidence has decreased in recent years, it continues to be an important cause of morbidity and mortality associated with high healthcare costs. The most important risk factors are Helicobacter pylori(H. pylori) infection and the use of non-steroidal anti-inflammatory drugs. Most patients with peptic ulcer disease remain asymptomatic, with dyspepsia being the most frequent and often characteristic symptom. It can also debut with complications such as upper gastrointestinal bleeding, perforation or stenosis. The diagnostic technique of choice is upper gastrointestinal endoscopy. Treatment with proton pump inhibitors, eradication of H. pylori and avoiding the use of non-steroidal anti-inflammatory drugs are the basis of treatment. However, prevention is the best strategy, it includes an adequate indication of proton pump inhibitors, investigation and treatment of H. pylori, avoiding non-steroidal anti-inflammatory drugs or using those that are less gastrolesive.
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Affiliation(s)
- Isabel Laucirica
- Servei d'Aparell Digestiu, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Departament de Medicina, Universitat Autònoma de Barcelona, Sabadell, España
| | - Pilar García Iglesias
- Servei d'Aparell Digestiu, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Departament de Medicina, Universitat Autònoma de Barcelona, Sabadell, España
| | - Xavier Calvet
- Servei d'Aparell Digestiu, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Departament de Medicina, Universitat Autònoma de Barcelona, Sabadell, España; Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, España.
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2
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Gong JW, Zhang Z, Luo TY, Huang XT, Huo JW, He XQ, Li Q. Development and validation of a CT algorithm for the identification of nonperforated duodenal bulb ulcer. Eur J Radiol 2023; 162:110761. [PMID: 36917926 DOI: 10.1016/j.ejrad.2023.110761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 01/18/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE To assess the value of multiplanar computed tomography (CT) in the diagnosis of nonperforated duodenal bulb ulcer (NPDBU). METHOD We retrospectively analyzed data from 135 patients with NPDBU (ulcer group) and 150 patients with a normal duodenal bulb (control group) who underwent contrast-enhanced abdominal CT and were diagnosed via upper endoscopy from January 2018 to February 2022. The clinical and CT features were compared between the two groups. Independent prognostic factors for diagnosing NPDBU were determined using binary logistic regression analysis. An external validation cohort to determine the model's efficiency comprised 80 patients from another center. RESULTS Gastrointestinal bleeding was more frequent in patients with NPDBU than in those without (p < 0.001). No significant differences in age and sex were observed between the groups (all p > 0.05). The duodenal bulbar wall was significantly thicker in the ulcer group than in the control group, as determined using CT (p < 0.001). Irregular mucosal surface, layered enhancement, and blurred fat space around the duodenal bulb were more common in the ulcer group than in the control group (all p < 0.001). Binary logistic regression analysis revealed that gastrointestinal bleeding, wall thickness of ≥ 4.85 mm, irregular mucosal surface, and blurred peripheral fat space were the most significant variations associated with NPDBU, with an area under the curve (AUC) of 0.974. The external validation cohort had an AUC of 0.916. CONCLUSIONS Careful multiplanar CT interpretation suggests the underlying presence of NPDBU and allows timely endoscopic verification and appropriate treatment.
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Affiliation(s)
- Jun-Wei Gong
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
| | - Zhu Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
| | - Tian-You Luo
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
| | - Xing-Tao Huang
- Department of Radiology, The Fifth People's Hospital of Chongqing, Chongqing 400062, China.
| | - Ji-Wen Huo
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
| | - Xiao-Qun He
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
| | - Qi Li
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
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Baghdanian AH, Baghdanian AA, Puppala S, Tana M, Ohliger MA. Imaging Manifestations of Peptic Ulcer Disease on Computed Tomography. Semin Ultrasound CT MR 2017; 39:183-192. [PMID: 29571554 DOI: 10.1053/j.sult.2017.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Although the overall prevalence of peptic ulcer disease (PUD) has decreased in modern times, its actual incidence may be underestimated owing to the nonspecific clinical presentations patients' manifest. The potential lethal complications that can result from PUD include life-threatening abdominal hemorrhage and bowel perforation that result in significant morbidity and mortality. Computed tomography (CT) imaging historically lacks specificity in detecting PUD-related pathology in the stomach and proximal small bowel segments. Therefore, these are potential pitfalls in the radiologist's search pattern on abdominopelvic CT imaging. This article highlights imaging features of uncomplicated PUD on CT imaging in order to allow for early detection of this disease process on imaging and the prevention of potential high-grade complications by recommending esophagogastroduodenoscopy.
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Affiliation(s)
- Arthur H Baghdanian
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA; Zuckerberg San Francisco General Hospital, San Francisco, CA.
| | - Armonde A Baghdanian
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA; Zuckerberg San Francisco General Hospital, San Francisco, CA
| | - Shilpa Puppala
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Michele Tana
- Department of Gastroenterology, University of California, San Francisco, San Francisco, CA; Zuckerberg San Francisco General Hospital, San Francisco, CA
| | - Michael A Ohliger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA; Zuckerberg San Francisco General Hospital, San Francisco, CA
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Kitchin DR, Lubner MG, Menias CO, Santillan CS, Pickhardt PJ. MDCT diagnosis of gastroduodenal ulcers: key imaging features with endoscopic correlation. ACTA ACUST UNITED AC 2015; 40:360-84. [PMID: 25117561 DOI: 10.1007/s00261-014-0207-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Although the overall prevalence of peptic ulcer disease (PUD) and related hospitalizations are decreasing, the initial presentation of complicated PUD on CT remains common. It, therefore, remains critical for radiologists to recognize the findings of PUD at CT for initial diagnosis. While the CT findings of complicated PUD have been previously described in the literature, the CT findings of uncomplicated PUD have not been well documented. Furthermore, although CT is certainly not the diagnostic evaluation of choice for patients with suspected uncomplicated PUD, many patients with PUD will nonetheless present to the emergency department with unexplained abdominal pain and undergo MDCT evaluation as the initial diagnostic test. Therefore, recognizing the MDCT findings of uncomplicated PUD can help appropriately direct patient management, and help prevent the development of complications. To facilitate improved recognition of PUD on abdominal CT, we present an overview of the CT findings of both uncomplicated and complicated PUD, as well as several diagnostic pitfalls which can result in misdiagnosis from peptic ulcer mimics.
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Affiliation(s)
- D R Kitchin
- Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI, 53792, USA,
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Singh T, Mendelson R. Case report: Confined penetration of a duodenal ulcer causing pancreatitis. J Med Imaging Radiat Oncol 2010; 54:47-9. [PMID: 20377715 DOI: 10.1111/j.1754-9485.2010.02136.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Confined penetration of a duodenal ulcer is an unusual cause of pancreatic gas and pancreatitis.
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Affiliation(s)
- T Singh
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia,
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Cho HS, Yoon SE, Park SH, Kim H, Lee YH, Yoon KH. Distinction between upper and lower gastrointestinal perforation: usefulness of the periportal free air sign on computed tomography. Eur J Radiol 2007; 69:108-13. [PMID: 17913427 DOI: 10.1016/j.ejrad.2007.08.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 08/04/2007] [Accepted: 08/22/2007] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the usefulness of the periportal free air (PPFA) sign on computed tomography (CT) to distinguish upper from lower gastrointestinal (GI) tract perforation. MATERIALS AND METHODS During a 30-month period, we retrospectively analyzed abdominal CT images of 53 consecutive patients with surgically proven GI tract perforation. We divided the patients into two groups, i.e. upper and lower GI tract perforation groups. According to the distribution of free air, we divided the peritoneal cavity into supramesocolic compartment and inframesocolic compartment. We observed the presence or absence of free air in each compartment in each group. When there was free air in the periportal area, it was defined as periportal free air (PPFA) and the sign was positive. To evaluate the usefulness of the PPFA sign, we compared the PPFA sign with the falciform ligament sign and the ligamentum teres sign, both of which are well-known CT signs of pneumoperitoneum. Statistical analyses were performed with univariate and multivariate analyses using SPSS version 11.5 for significant findings among the CT signs. RESULTS Free air was seen in supramesocolic compartment in 29 of 30 (97%) patients in the upper GI perforation group and in 17 of 23 (74%) in the lower GI perforation group. Free air in inframesocolic compartment did not show significant difference in either group (p=.16). The PPFA sign was seen in 28 of 30 (93%) patients with upper GI tract perforation, but in only 8 of 23 (35%) patients with lower GI tract perforation (p<.0001). The falciform ligament sign was seen in 24 of 30 (80%) patients with upper GI tract perforation and in 10 of 23 (43%) patients with lower GI tract perforation (p=.020). The ligamentum teres sign was seen in 16 of 30 (53%) patients with upper GI tract perforation and in 2 of 23 (8%) patients with lower GI tract perforation (p=.008). Multivariate logistic regression analysis showed that the PPFA sign was the only variable, which adjusted odds ratio of 15.5 (p=.002). CONCLUSION The PPFA sign is a useful finding which can help to distinguish upper from lower GI tract perforation. When this sign is present, upper GI tract perforation is strongly suggested.
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Affiliation(s)
- Hyun Sun Cho
- Department of Radiology, Wonkwang University School of Medicine, 344-2 Sinyong-dong, Iksan, Jeonbuk 570-711, South Korea
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Abstract
Peptic ulcer disease (PUD) can present with many complications including inflammation, ulceration and perforation. Improvements in CT have enabled better imaging of the gastroduodenal area. Three cases of complicated PUD detected on CT are presented with a brief review of the current literature.
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Affiliation(s)
- E Pun
- Ballarat Base Hospital, Department of Medical Imaging, Ballarat, Victoria, Australia.
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Abstract
Perforations of the gastrointestinal tract have many causes. Holes in the wall of gastrointestinal organs can be created by blunt or penetrating trauma, iatrogenic injury, inflammatory conditions that penetrate the serosa or adventitia, extrinsic neoplasms that invade the gastrointestinal tract, or primary neoplasms that penetrate outside the wall of gastrointestinal organs. This article provides a radiologic approach for investigating the wide variety of gastrointestinal perforations. General principles about contrast agents and studies are reviewed, and then perforations in specific gastrointestinal organs are discussed.
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Affiliation(s)
- Stephen E Rubesin
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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Abstract
Helical computed tomography (CT) allows rapid, cost-effective evaluation of patients with acute abdominal pain. Tailoring the examination to the working clinical diagnosis by optimizing constituent factors (eg, timing of acquisition, contrast material used, means and rate of contrast material administration, collimation, pitch) can markedly improve diagnostic accuracy. Rapid (>/=3 mL/sec) intravenous injection of contrast material is required for optimal assessment of acute pancreatitis, ischemic bowel, aortic aneurysm, and aortic dissection. Narrow collimation and small reconstruction intervals can help detect calculi in the biliary system and genitourinary tract. Tailored helical CT in patients with acute pyelonephritis usually involves several acquisitions through the kidneys during various phases of renal enhancement. In patients with suspected renal infarction, CT protocol must include an acquisition during the corticomedullary phase. Helical CT with 5-mm collimation through the lower abdomen and pelvis is used to evaluate patients with suspected diverticulitis. Use of both oral and intravenous contrast material can help localize small bowel perforation and characterize related complications. Tailored helical CT for assessment of abdominal hemorrhage consists of initial unenhanced CT followed by optional contrast material-enhanced CT. Clear communication between the radiologist, the patient, and the referring physician is essential for narrowing the differential diagnosis into a working diagnosis prior to helical CT.
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Affiliation(s)
- B A Urban
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 600 N Wolfe St, Baltimore, MD 21287, USA.
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Killeen KL, DeMeo JH, Mullaney JM. Splenic penetration by a benign gastric ulcer: Preoperative computed tomographic diagnosis. Emerg Radiol 1997. [DOI: 10.1007/bf01508034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lichtenstein JE. INFLAMMATORY CONDITIONS OF THE STOMACH AND DUODENUM. Radiol Clin North Am 1993. [DOI: 10.1016/s0033-8389(22)00322-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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13
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Ranschaert E, Rigauts H. Confined gastric perforation: ultrasound and computed tomographic diagnosis. ABDOMINAL IMAGING 1993; 18:318-9. [PMID: 8220026 DOI: 10.1007/bf00201771] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A case of confined gastric perforation due to a penetrating antral ulcer diagnosed on ultrasound and computed tomography is presented. Air bubbles were visualized adjacent to the anterior gastric and bulbar wall, associated with small amounts of fluid in the subhepatic region and in the omental bursa. Careful examination of the subhepatic region and upper abdominal cavity in a patient with acute epigastric pain may lead to a correct diagnosis of such confined perforations.
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Affiliation(s)
- E Ranschaert
- Department of Radiology, University Hospitals of Leuven, U.Z. Gasthuisberg, Belgium
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Fultz PJ, Skucas J, Weiss SL. CT in upper gastrointestinal tract perforations secondary to peptic ulcer disease. GASTROINTESTINAL RADIOLOGY 1992; 17:5-8. [PMID: 1544559 DOI: 10.1007/bf01888496] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Computed tomographic (CT) scans of 11 patients with perforations of the stomach or duodenum were reviewed to determine the variety and relative conspicuity of findings. Five patients had de novo presentation due to perforation of peptic ulcers, two had perforations at ulcer repair sites, and the remaining four patients had ulcer perforations following unrelated surgery. CT allowed recognition of at least one component of bowel perforation, such as extra-gastrointestinal gas and/or contrast, in most patients. In only three patients (27%), however, could these findings be specifically related to a perforation of the stomach or duodenum from the CT scans alone.
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Affiliation(s)
- P J Fultz
- Department of Diagnostic Radiology, University of Rochester School of Medicine and Dentistry, New York 14642
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CT of the Stomach and Duodenum. Radiol Clin North Am 1989. [DOI: 10.1016/s0033-8389(22)02154-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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