Solitary ulcers in reflux esophagitis: radiographic findings

Some patients with reflux esophagitis have solitary ulcers in the distal esophagus. This study was undertaken to characterize further the radiographic features of these ulcers and to determine whether or not they have a predisposition to develop on the posterior esophageal wall.

Radiologic files and teaching files at our university hospital and affiliated Veterans Administration hospital revealed 29 patients with solitary reflux-induced ulcers. The radiographs were reviewed retrospectively to determine the size and location of the ulcers as well as the presence or absence of other findings.

Twenty ulcers (69%) were located on the posterior wall, five (17%) on the left or right lateral wall, and four (14%) on the anterior wall. All but two ulcers were located 1-4 cm from the gastroesophageal junction. All of the ulcers were less than 10 mm in width and 5 mm in depth. Other associated findings included hiatal hernias in 11 patients (38%), mucosal nodularity or granularity in 12 (41%), one or more tiny satellite ulcers in three (10%), esophageal intramural pseudodiverticula in three (10%), an inflammatory esophagogastric polyp in one (3%), and scarring or stricture formation in 12 (41%).

Our findings suggest that solitary reflux-induced ulcers tend to occur on the posterior wall of the distal esophagus near the gastroesophageal junction, producing characteristic radiographic findings. We postulate that affected individuals sleep primarily in the supine position, so that refluxed acid pools on the dependent or posterior esophageal wall, causing maximal injury in this location.