Roentgenological Study on Gastric Ulcer Scar

Abstract

Since the first description of ulcer niche by Reiche (1909) and Haudeck (1910), there is a remarkable advantage in the field of x-ray diagnosis on gastric ulcer. Now a days, it becomes fairly easy, accompanied with a recent progress in the field of endoscopical diagnosis, not only to detect the lesion but also to demonstrate their fine details for making a differential diagnosis or for a roentgenological observation of the course of the lesion.
However, the main subjects of past reported numerous studies on the x-ray diagnosis of gastric ulcer, were usually directed only to the morphological aspect of the crater of the lesion, while in a few reports the problems and x-ray findings of ulcer scar are discussed. The reason of this fact is considered to depend mainly upon the under-development of the radiographical technic.
Now, the technic has improved enough to demonstrate such lesions and to discuss the following problems: judgment of the gastric ulcer whether it is healed or not, problems of recurrence or resurrection of the lesion, epidemiologic feature of gastric ulcer, differential diagnosis between ulcer scar and some type of superficial spreading carcinoma and, by any chance, pathogenetic problem of “scar-cancer”. Furthermore, Pathogenetic course of gastric ulcer itself would be clarified, if the whole course of gastric ulcer including even in its cicatrix stage could be observed roentgeno-morphologically.
Objects of the study and the material
The author examined the cases of gastric ulcer roentgenologically as minutely, as periodically and as long-datedly as possible, and thus tried to follow successively the healing process of gastric ulcer and the changing phases of the x-ray findings even after vanishing of the ulcer niche.
Several objective points are as follows:
1) Is it possible to diagnose gastric ulcer scar roentgenologically
2) If possible, what kind of findings lead to the diagnosis, and with what degree of certainty?
3) Are several types of scar differentiated roentgenologically?
4) Is the x-ray findings of scar changing as the time passes?
The materials are limited to 50 cases of round or elliptic gastric ulcer which was successfully demonstrated roentgenologically several times during an observation period intended. That is, saddle ulcer, linear ulcer, kissing ulcer and multiple ulcer are excluded.
Interval of taking picture
X-ray examinations on these cases, mainly by double contrast method and barium filling method, have been performed once in two weeks in their ulcerative stage and three to four times a year after vanishing of the crater for a period of one to five and half year since the first visiting of the patients.