Radiographic evaluation of peptic ulcer disease

The major advance in the radiographic detection of peptic ulcers and their sequelae in the past decade has been the utilization of air-barium double-contrast studies of the esophagus, stomach, and duodenum. In many reported series, a decrease in the error rate, from 20-50% using single-contrast radiography, to 10-20% using double-contrast or combination single- and double-contrast radiographic techniques, has been noted. Double-contrast radiography has had a particularly great impact in the diagnosis of duodenal, gastric, and esophageal erosions. These shallow, superficial changes are not detected with single-contrast radiography. False-negative radiographic diagnoses still occur with double-contrast techniques because of (1) erosions too small to detect, (2) ulcers obscured by enlarged folds or a deformed duodenal bulb, and (3) poor mucosal coating and increased secretions. False-positive diagnoses occasionally occur because of precipitation or trapping of barium between gastric and duodenal folds. The improvements in overall radiographic diagnosis using a double-contrast technique indicate that this technique should be employed whenever possible for the evaluation of peptic ulcer disease.