Clinically relevant reflux is assessed by 24 h pH probe monitoring and by endoscopic evidence of oesophagitis. If reflux is observed, images are taken to record the level to which it ascends.
The administration of Buscopan has been shown to not affect the detection of gastro-oesophageal reflux or hiatus hernia.
Good coating has been achieved if the areae gastricae in the antrum are visible.
This sequence of movements is required to avoid barium flooding into the duodenal loop, which would occur if the patient were to roll onto the right side to achieve a prone position.
Additional views of the fundus in an erect position may be taken at this stage, if there is suspicion of a fundal lesion. 5. Spot images of the oesophagus are taken, while barium is being swallowed, to complete the examination
ulcers greater than 3 cm in size
Ulcer healing may lead to the development of ulcer scars, which are visible on double contrast studies in up to 90% of patients with healed gastric ulcers. These scars are usually characterized by a central depression, radiating folds, and/or retraction of the adjacent gastric wall.2
When benign ulcers arise on the greater curvature, they are almost always on the distal half of the greater curvature, and nearly 100% are found to be caused by ingestion of aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs).2
With a greater degree of edema, ulcers may be associated with a wide radiolucent band at their orifice (also known as an ulcer collar) or a smooth, bi-lobed hemispheric mass on both sides of the ulcer (also known as an ulcer mound)
Importance of positioning as in image A not seen but after prone position visible on image B
The presence of normal areae gastricae extending to the ulcer crater is a sign of benignancy.
This large ulcer ( arrows ) on the greater curvature has an apparent intraluminal location and is associated with thickened, irregular folds and considerable mass effect from a surrounding mound of edema. B. In another patient, thickened, irregular folds are seen abutting a large greater curvature ulcer ( arrows ).
Benign greater curvature gastric ulcers are almost always located on the distal half of the greater curvature
Consists of carmen meniscus sign plus elevated rim of tumour surrounding the crater.
because studies performed sooner are unlikely to show complete healing.
A. A round ulcer ( arrow ) is seen adjacent to the lesser curvature. B. Follow-up study several weeks later shows splitting of the ulcer with two closely spaced niches ( arrowheads ) at the site of the original crater.
