Peptic ulcer X ray

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Case #1

2017 ACG Guidelines for Peptic Ulcer Disease

Guidelines for the Indications to Test for, and to Treat, H. pylori Infection

Guidelines for First line Treatment Strategies of Peptic Ulcer Disease for Providers in North America

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Guidelines to document H. pylori antimicrobial resistance in the North America

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]


If a peptic ulcer perforates, air will leak from the inside of the gastrointestinal tract (which always contains some air) to the peritoneal cavity (which normally never contains air). This leads to "free gas" within the peritoneal cavity. If the patient stands erect, as when having a chest X-ray, the gas will float to a position underneath the diaphragm. Therefore, gas in the peritoneal cavity, shown on an erect chest X-ray or supine lateral abdominal X-ray, is an omen of perforated peptic ulcer disease.

X Ray

There are no abdominal x-ray findings associated with peptic ulcer disease. However, an x-ray may be helpful in the diagnosing the complications of underlying disease. Findings of abdominal X-ray in perforated peptic ulcer include free air under the diaphragm called as pneumoperitoneum.[1][2]

PneumoperitoneumSource:Case courtesy of A.Prof Frank Gaillard[3][4]

Barium swallow

The barium swallow is also used to diagnose peptic ulcer and to differentiate between benign and malignant ulcer.[5]

Distinguishing features between benign and malignant ulcer

Barium swallow helps to distinguish between benign and malignant ulcer

Barium swallow findings
Benign ulcer Malignant ulcer
Smooth rounded and deep ulcer crater Irregular and shallow ulcer crater
Smooth ulcer mound Nodular and angular ulcer mound
Smooth folds that reach the margin of the ulcer Nodular gastric folds that do not reach the ulcer margin
Hampton's line[5] Carman meniscus sign


  1. {{cite journal |vauthors=Søreide K, Thorsen K, Harrison EM, Bingener J, Møller MH, Ohene-Yeboah M, Søreide JA |title=Perforated peptic ulcer |journal=Lancet |volume=386 |issue=10000 |pages=1288–1298 |year=2015 |pmid=26460663 |pmc=4618390 |doi=10.1016/S0140-6736(15)00276-7 |url
  2. Thorsen K, Glomsaker TB, von Meer A, Søreide K, Søreide JA (2011). "Trends in diagnosis and surgical management of patients with perforated peptic ulcer". J. Gastrointest. Surg. 15 (8): 1329–35. doi:10.1007/s11605-011-1482-1. PMC 3145078. PMID 21567292.
  3. ="">
  4. ="">rID: 17957
  5. 5.0 5.1 Nawaz M, Jehanzaib M, Khan K, Zari M (2008). "Role of barium meal examination in diagnosis of peptic ulcer". J Ayub Med Coll Abbottabad. 20 (4): 59–61. PMID 19999206.

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