Gastric Ulcer

Left: 45 year-old man with a history of ulcer disease, taking corticosteroids for rheumatoid arthritis (but no nonsteroidal agents). Symptoms were limited to dyspepsia (indigestion). Endoscopy demonstrated a 1 cm ulcer in the gastric antrum. The ulcer crater is fairly superficial and has a benign appearance, with smooth margins.

Center: 76 year-old women with incomplete healing of an antral gastric ulcer.

Right: 58 year-old women with abdominal pain. Endoscopy revealed a lesser curvature gastric ulcer, with a clean fibrinous base, and surrounding inflammation.

Left: 82 year-old man with intermittent dyspepsia (indigestion) and a history of a chronic gastric ulcer. Endoscopy demonstrated a large ulcer in the proximal gastric body, seen best by retroflexing the endoscope, which enables visualization of the upper portion of the stomach from below (and which causes the instrument to "look back" on itself as it enters the stomach from above). Repeated biopsies were benign, nor did they reveal evidence of Helicobacter pylori. Though the patient had no clinical evidence of bleeding, there is a small vascular spot in the ulcer bed, suggesting at least some potential for bleeding.

Right: 62 year-old man with abdominal pain (for which he was taking ibuprofen!), non-bloody vomiting, anemia and weight loss. Endoscopy revealed this 1.5-2 cm ulcer in the gastric antrum, deeply penetrating the gastric wall. The ulcer crater was benign on biopsy, but did show Helicobacter pylori.