In total, 95% of cases are benign and most are secondary to Helicobacter pylori (alcohol and nonsteroidal anti-inflammatory drugs [NSAIDs]...
• Benign ulcers are mostly found on the lesser curve (NSAIDs and malignant ulcers tend to affect the greater curve, ‘sump ulcer’).
• Barium collects in a round/oval pit on the dependent wall.
• Penetration sign—ulcer projects beyond the gastric lumen when viewed in profile.
• Smooth gastric fold extending to the edge of the ulcer crater.
• Areae gastricae and rugae are seen within the oedema up to the ulcer crater (otherwise, malignancy is suggested).
• Hampton’s line = narrow lucent line (1-2 mm) crossing the neck of the ulcer—indicates a benign ulcer.
• Aphthous ulcers are up to 2 mm in size, shallow and usually due to H. pylori.
• The most reliable sign of a benign ulcer is healing after treatment.
• Malignant ulcers rarely heal and are eccentric in a tumour mound—other signs include the ‘Carman meniscus’, absent Hampton line, etc.
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