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X-ray signs of diseases of the stomach and duodenum. Gastroscopy as the main diagnostic method. How to detect early stage cancer on a stomach x-ray

Abnormalities of the stomach are quite rare, especially compared to abnormalities of the esophagus. They usually become noticeable at older ages. Abnormalities of the stomach may not appear at all during life. However, sometimes they can be the cause of urgent surgical interventions in newborns and infants. If an anomaly is suspected, perform x-ray of the stomach using required quantity contrast agent.

Among the stomach anomalies are:

doubling of the stomach;
narrowing of the antrum;
pyloric stenosis;
fold gigantism;
congenital and acquired gastric diverticula;
reverse position of the stomach and other internal organs;
"chest" stomach.

Gastric abnormalities are rarely life-threatening. However, such conditions increase the risk of developing peptic ulcer and chronic gastritis. Abnormalities of the stomach can theoretically be combined with abnormalities of other organs, therefore for such people it is necessary to carry out preventive examinations, which include x-ray, and it is recommended to be registered with a dispensary.

Functional disorders of the stomach are divided into the following groups:

violation of gastric tone;
change in peristalsis;
secretion disorder.

Functional disorders of the stomach can be observed in various pathological conditions, for example, gastritis. However, dysfunction of the stomach itself can cause diseases. Thus, an increase in gastric secretion leads to the appearance of ulcers. To detect functional disorders of the stomach, x-ray is a fairly effective diagnostic method.

Complete and partial duplication of the stomach on x-ray

Doubling the stomach is very rare anomaly, which is usually found in childhood. Duplication of the stomach is the presence in the body of an abnormal formation that in one way or another resembles the structure of the stomach. Such a formation has a lumen connected to the main stomach, as well as a wall consisting of all layers of a normal stomach. The accessory stomach can be either functional or not involved in digestion.

There are the following options for doubling the stomach:

Full doubling. In this case, the second part of the stomach is fully involved in digestion.
Partial doubling. With partial doubling, tubes or cysts are formed in which digestion does not occur.

Duplications are most often located at the left and posterior wall of the stomach. If the mucous membrane retains the ability to secrete enzymes and hydrochloric acid, a cyst may form. The appearance of this formation on x-ray depends on the possibility of the contrast agent getting into the double stomach. Using X-rays, it can be difficult to distinguish between a doubling of the stomach and, for example, a tumor process.

X-ray picture of gastric diverticula

Diverticula are protrusions of the stomach wall in the form of a bag. Their appearance is associated with weakness of the muscle layer. Gastric diverticula can be congenital or acquired, but much more often they appear after 40 years.
Diverticula can range in size from a few millimeters to 5 centimeters in diameter.

Most often, diverticula are located in the following parts of the stomach:

cardiac section ( 75% );
pyloric region;
body of the stomach.

Diverticula have a typical x-ray appearance, but on x-ray they can be confused with an ulcerative defect of the mucous membrane. Unlike an ulcer, a diverticulum is connected to the stomach cavity by a narrow neck, in which folds are preserved. The wall of the diverticulum is elastic and retains the ability to contract. The diverticulum is filled with a completely contrasting suspension, and its contour is smooth and oval, while in an ulcer it is usually jagged or irregular.

A complication of diverticulum is inflammation of the stomach wall - diverticulitis. In this case, the wall of the diverticulum becomes inflamed and swollen. Barium mass is retained in the cavity of the diverticulum, liquid and gas accumulate. These areas create a three-layer effect. When the neck of a diverticulum spasms, necrosis of its contents may occur, so in this case an operation is performed to remove it.

Diagnosis of gastric hernia using x-ray

A gastric hernia is nothing more than a hernia of the esophageal diaphragm. With this disease, part of the stomach penetrates into the chest cavity through a hole in the diaphragm. Sometimes the abdominal esophagus enters the chest cavity along with the stomach. Such a hernia is formed due to a short-term increase in pressure in the abdominal cavity. Hernias are more common in old age, when muscles lose strength and elasticity.

A gastric hernia is easily diagnosed by X-ray with contrast agent. The hernial sac is well stained with a contrast agent. The difference between a hernia and a diverticulum is that the hernia is located not in the abdominal cavity, but in the chest. To clarify the diagnosis and exclude complications, a biopsy or computed tomography is sometimes performed ( CT) abdominal cavity.

Hiatal hernia is controlled through diet. Surgical treatment of a hernia is also quite effective, but if possible, it is better not to perform surgery, but to treat it conservatively. Gastric hernia long time may be asymptomatic.

Congenital and acquired pyloric stenosis on an x-ray of the stomach

The pylorus is an important part of the stomach, since the quality of its functioning determines the quality of food digestion in the stomach and intestines. The work of the pylorus is regulated both by neuromuscular mechanisms and by local hormones ( motilin). When the pylorus is affected, the risk of peptic ulcer disease increases and, conversely, ulcers of this section often cause acquired stenosis.

Pyloric stenosis can be of two types:

congenital;
acquired.

Congenital pyloric stenosis is caused by hypertrophy muscle wall. The narrowing of the pylorus is accompanied by its lengthening to 4 centimeters. In adults, pyloric stenosis is caused by scar deformation after an ulcer, as well as local spasm. If at congenital stenosis While there may be no complaints from the pylorus, in adults pyloric stenosis is accompanied by pain.

Radiological signs of pyloric stenosis are:

narrowing of the pyloric lumen of 0.5 cm or less;
lengthening of the pyloric canal;
increased peristaltic waves;
thickening of the folds of the mucous membrane or their deformation;
slow evacuation of barium mass from the stomach;
slow filling of the intestines with barium mass.

Regardless of the cause of the pathology, narrowing of the pylorus is controlled through diet, as well as the prevention and treatment of gastric ulcers. In children and adults severe cases resort to surgical treatment, during which the patency of the final section of the stomach is ensured.

Aperture ( partial narrowing) antrum on x-ray

Anomalies in the structure of the stomach include the formation of membranes that divide the stomach cavity into several chambers. This anomaly is quite rare, its formation mechanism is similar to the formation of membranes in the esophagus. Such membranes are usually detected before age 7. They consist of a mucous membrane and a submucosa and are most often located in the antrum. The diameter of the hole in the membrane is about 1 centimeter, which causes difficulty in feeding the child, lack of appetite, and rapid satiety.

An x-ray reveals difficulty in filling the part of the stomach lying behind the diaphragm. If its lumen is large enough, then without double contrast the diaphragm may be invisible. If a gastric diaphragm is suspected, a small amount of barium mass is used to color its outline, but not to completely block it. The diaphragm of the antrum can be combined with an ulcer, and the following symptoms may appear - pain, burning associated with eating.

Atony and hypotension of the stomach on x-ray

The wall of the stomach is constantly in a state of tonic contraction due to the presence of a muscle layer. Intestinal atony is a condition in which the tone of the stomach is almost completely absent. Hypotension is characterized by a partial weakening of the tone of the muscular wall of the stomach. These conditions are manifested by distension and bloating. Atony occurs suddenly, while gastric hypotension can go unnoticed for a long time.

Highlight following reasons decreased stomach tone:

abdominal trauma;
cachexia ( exhaustion due to malnutrition or various diseases);
postoperative period;
stress, emotional overstrain;
intoxication ( including alcohol);
infectious diseases;
chronic gastritis and other stomach diseases.

On x-ray, reduced tone is diagnosed when the barium mass first enters the stomach. With reduced tone, it quickly descends down to the corner of the stomach and does not linger in the upper section. The stomach is elongated and expanded, the pyloric sphincter does not retain food in the stomach, as is normal, but is opened. When pressing on the abdomen, the shape of the stomach can change dramatically.

Gastric hypotension - dangerous condition. Food in such a stomach cannot be completely digested, and as a result, a person does not receive enough vitamins and nutrients. The effect of the acidic environment of the stomach sharply increases the risk of gastric and intestinal ulcers. To eliminate gastric hypotension, it is necessary to treat its root cause. After surgical interventions, it is necessary to apply physical activity in doses. It will help restore the tone of skeletal muscles and muscles of internal organs.

Increased tone ( hypertension) stomach on x-ray. Stomach spasm

The tone of the stomach increases in some diseases, which is specific defensive reaction. Gastric hypertension is observed during intoxication, as well as peptic ulcer disease. With strong muscle contraction a spasm occurs, which is accompanied by pain in the upper abdominal cavity. Pain due to stomach diseases is most often explained by spasmodic contraction of the stomach muscles.

With hypertension, an x-ray reveals a small horn-shaped stomach. The gas bubble is spherical, and the contrast mass penetrates into it for a very long time. lower sections. The evacuation time of the barium mass is also increased. Atypical transverse folds may be observed in the stomach.

Stomach spasms can deform the stomach wall. Local spasm is usually associated with a stomach ulcer. In this case, on an x-ray, the stomach takes the shape of “ hourglass"- local narrowing between two wider areas. In order to distinguish gastric spasm from cicatricial deformity, the subject is given atropine, after which the spasm goes away for a short time. To reduce tone and relieve stomach spasms, antispasmodics are used ( no-shpa), diet, gastric lavage with potassium permanganate, chamomile decoction.

Is it possible to detect increased or decreased secretion of gastric juice using an x-ray?

The amount of gastric juice secreted is regulated by nervous mechanisms and is determined by the body quite accurately. With its deficiency, the food consumed is not digested well enough, and with an increase in gastric juice, there is a danger of damage to the gastric wall. Organic disorders of the peripheral or central are to blame for the violation of secretion nervous system. These are the causes of many pathological conditions.

Hypersecretion of gastric juice is a symptom of the following diseases:

peptic ulcer;
antral gastritis;
spasm and stenosis of the pyloric sphincter.

With increased secretion, the amount of gastric juice released can be up to 1 liter within half an hour. Gastric juice can be released spontaneously or in response to food intake. In any case, the patient suffers from heartburn, poor appetite, and sometimes even vomiting gastric juice. Conclusions about hypersecretion can be made from an x-ray. An x-ray shows a horizontal level of liquid, and when the stomach is filled with a contrast mass, there are areas near the folds where the contrast mass does not penetrate. Today there are drugs that artificially reduce the secretion of gastric juice, normalizing the function of the stomach.

A decrease in the secretion of gastric juice is called achylia. Achylia cannot be diagnosed using x-rays, but it is often accompanied by decreased gastric tone and weakened peristalsis, which has certain radiological signs. Achylia is diagnosed using a histamine test. Reduced gastric secretion leads to the formation of mucosal polyps and chronic gastritis.

Duodenogastric reflux on x-ray

Duodenogastric reflux is the reflux of small intestinal contents into the stomach. The reverse flow of food into the stomach is caused by insufficiency of the muscular pyloric valve. The intestinal contents contain digestive gland enzymes that can damage the stomach lining. Despite this, duodenogastric reflux observed in half healthy people. This condition is not considered a disease, but it is believed that various stomach diseases can occur due to reflux.

Duodenogastric reflux can cause the following stomach diseases:

peptic ulcer;
chronic gastritis;
pyloric stenosis;
malignant tumors.

Duodenogastric reflux is detected using endoscopic examination. Quite rarely, X-rays show reverse movement of the contrast mass after complete emptying of the stomach. However, with the help of x-rays, you can see the changes in the mucous membrane that were caused by this phenomenon. They are characterized by a defect in the mucous membrane in the form of a niche, as well as an increase or, conversely, a decrease in the folds of the mucous membrane as they atrophy.

Diagnosis of acute and chronic gastritis using x-rays

Diagnosing gastritis is a difficult task. This is due to the fact that this disease does not have specific symptoms. Abdominal pain, vomiting and nausea can occur with a large number of diseases. On an x-ray you can see changes in the mucous membrane, but they are also not permanent with gastritis. Therefore, in order to make a diagnosis of chronic gastritis, the doctor carefully studies the patient’s complaints and uses various diagnostic methods. All this is necessary for successful treatment gastritis.

Chronic gastritis on an x-ray of the stomach

Inflammation of the gastric mucosa is a common disease. It is believed that it occurs in almost 50% of the world's population. This is due to the accelerated pace of life and eating disorders modern man. Spicy foods, alcohol, medications - all of this, to a certain extent, destroys the gastric mucosa.
The bacterial flora of the stomach plays a certain role. In this case, inflammation of the gastric mucosa has subtle symptoms and does not appear for a long time. Therefore, gastritis most often has a chronic form.

Chronic gastritis is manifested by indigestion, changes in stool, and insufficient digestion of food. During exacerbations, discomfort and pain in the stomach may appear. These symptoms suggest chronic gastritis and are an indication for an X-ray examination. It is with the help of X-rays that one can study the relief of the mucous membrane, which changes significantly during chronic gastritis. Visual diagnosis of the mucous membrane can be carried out using gastric endoscopy.

Chronic gastritis can have the following clinical forms:

Catarrhal. Characterized by swelling and inflammatory enlargement of the folds of the mucous membrane.
Erosive. Inflammation includes the formation of mucosal defects in the form of erosions.
Polypoid. The growth of the mucous membrane, which is observed in response to inflammation, takes on the appearance of polyps. They may disappear completely when the condition returns to normal.
Sclerosing ( rigid). With this type of chronic gastritis, deformation of the stomach wall and disruption of its contraction occur.

Chronic gastritis can be local or widespread throughout the gastric mucosa. Most often, chronic gastritis begins in the antrum of the stomach. This disease, despite the variety of forms, is distinguished by characteristic radiological signs. To identify them, it is necessary to fill the stomach with barium mass using double contrast, which improves the staining of the folds of the stomach.

The main radiological signs of chronic gastritis are:

Increased gastric fields. The gastric fields, located in the body of the stomach, are the exit ducts of the glands of the mucous membrane. With chronic gastritis, the diameter of these fields becomes more than 3–5 mm, x-ray they acquire a granular appearance due to the penetration of the contrast mass deep into the dilated ducts.
Expansion of folds of the mucous membrane. Chronic gastritis is characterized by disruption of the folds of the mucous membrane. There is more space between them, which creates the appearance of jaggedness on an x-ray. However, chronic gastritis can also be observed with normal mucosal texture.
Increased mucus secretion. Mucus is a protective layer between the epithelium of the stomach wall and the acidic environment of the gastric contents. With chronic gastritis, its amount increases. Mucus can interfere with the contrasting mass staining the folds. This effect of blurred folds is called marble relief of the mucous membrane.
Violation of stomach tone. With chronic gastritis, the tone of the stomach decreases, and the rate of its clearing of barium mass is reduced. With exacerbations of gastritis, the tone may increase. The patient may feel an increase in tone in the form of spastic pain.

Erosive chronic gastritis on x-ray

Erosive gastritis is characterized by the formation of defects in the mucous membrane. Erosions form if the irritant in chronic gastritis lasts long enough. The mechanism of formation of erosions resembles the principle of development of peptic ulcers, however, erosions have a smaller depth and diameter and are located within the mucous membrane. The presence of erosions does not affect the symptoms of the disease, since there is no innervation in the mucous membrane.

Erosions are usually located on the anterior or back wall. On an X-ray, such erosions look like a spot up to 1 centimeter in size. When located in the area of the left or right contour of the stomach, erosions look like a small accumulation of barium mass. However, more often such erosions are not visible due to small size. Taking pictures in different projections helps in determining them. Erosion of the mucous membrane must be distinguished from an ulcerative defect and from tumor processes. Examination of the gastric mucosa using endoscopy can help with this.

Erosive process, unlike stomach ulcers, is reversible. The mucous membrane can be restored, since the epithelium has the ability to regenerate. To treat erosive chronic gastritis, drugs are used that reduce the activity of microflora, as well as medications that reduce the secretion of gastric juice. In addition to a special diet, gels can be used that envelop the wall of the stomach and protect it from irritants.

Polypoid and rigid chronic gastritis on x-ray

The formation of polyps and rigidity of the stomach wall are late manifestations of chronic gastritis. Chronic inflammation sooner or later leads to atrophy of the mucous membrane. Because of this, the gastric mucosa becomes less functional and is replaced by other structures. In order to prevent this, it is necessary to monitor the diet and promptly treat chronic gastritis.

Warty growths of the mucous membrane appear against the background of smoothed folds of the mucous membrane. Their size does not exceed 5 mm. They are also covered with mucus and may not be visible when located between the folds. On x-ray, polyp-shaped gastritis is characterized by small protrusions with unclear boundaries inside the stomach against the background of a changed mucous membrane. This form of the stomach must be distinguished from tumor formations mucous membrane. They are large in size, and the mucous membrane around them is not changed.

Rigid chronic gastritis develops in the antrum. It occurs slowly and leads to a decrease in muscle activity in the area. Chronic inflammation in rigid gastritis leads to the formation of excess connective tissue in the deep layers of the gastric wall.

Rigid chronic gastritis is characterized by the following radiological signs:

antral deformation;
disturbance of gastric tone and peristalsis;
change in the relief of the mucous membrane.

The deformity of the antrum has the shape of a cone. The pyloric section is also lengthened. Over time, this deformation becomes stable; a peristaltic wave does not pass through this section. The mucous membrane has a jagged appearance, the folds are located chaotically. Rigid chronic gastritis tends to degenerate into a malignant tumor located inside the stomach wall.

Acute gastritis. Diagnosis of acute gastritis using x-rays

Acute gastritis, caused short-term action strong irritants to the gastric mucosa. Acute gastritis is caused by chemical substances, some medications if used incorrectly, food contaminated with microorganisms. Unlike chronic gastritis, acute form passes without a trace and usually leaves no reminders behind. At acute gastritis the patient is bothered by severe pain in the upper abdomen, which can be eliminated by gastric lavage, painkillers and antispasmodics.

Acute gastritis has the following forms:

Catarrhal gastritis. This is the most light form, since only the superficial layers of the mucous membrane are affected. They are quickly replaced by new cells when the irritants are removed. Catarrhal gastritis is accompanied by swelling of the mucous membrane and large mucus formation.
Erosive gastritis. Acids and alkalis can form defects in the mucous membrane in high concentrations. If the defect reaches the submucosa, then over time scarring and narrowing of the lumen of the stomach occurs.
Phlegmonous gastritis. Bacteria rarely develop in the stomach due to the acidic environment of gastric juice. However, when they develop, an accumulation of pus forms in the wall of the stomach ( phlegmon). This dangerous condition is accompanied by pain, nausea and vomiting and requires surgical treatment.

X-ray acute gastritis differs from chronic form. Barium mass in acute gastritis does not fill the stomach well. The folds of the mucosa are practically invisible, since they are shrouded in mucus and are inaccessible to the contrast agent. The stomach is reduced in size, as its wall is in tonic contraction. Inflammatory edema may look like a uniform protrusion of a section of the wall into the lumen of the stomach. In the presence of erosions, filling defects are detected.

Diagnosis of peptic ulcers and tumor formations of the stomach using x-rays

Peptic ulcer is a very common disease of the gastrointestinal tract. It manifests itself in at a young age, about 25 - 30 years old, and significantly reduces the quality of life at an older age. The main way to prevent stomach ulcers is to follow correct mode nutrition. Frequent, fractional meals in small portions 4 to 5 times a day are considered optimal.

The X-ray method is a very convenient way to diagnose stomach ulcers. A large number of direct and indirect signs make it possible to almost accurately diagnose a stomach ulcer. Gastric ulcers are diagnosed using contrast agents. To do this, a series of images is taken during which the gastric mucosa is examined at varying degrees its filling.

Tumor diseases of the stomach are detected on x-ray if their size is more than 3 mm. Difficulties also arise in distinguishing between benign and malignant tumors. Therefore, if necessary, an X-ray of the stomach with contrast is supplemented with computed tomography, endoscopy or biopsy ( microscopy of a piece of tissue). Only with the help of a biopsy can the exact nature of the tumor be established.

Peptic ulcer disease. X-ray signs of a stomach ulcer

Gastric ulcer is a condition in which a defect forms in the mucous membrane under the influence of of hydrochloric acid and gastric juice enzymes. Stomach ulcers are often multiple, so they speak of peptic ulcer disease. The biggest role Bacteria of the genus Helicobacter play a role in the development of peptic ulcers. These bacteria develop comfortably in acidic gastric contents, reduce the resistance of the epithelium to acids and enzymes and cause local inflammation. An increase in gastric secretion plays a significant role.

During peptic ulcer disease, the following stages are distinguished:

pre-ulcerative condition;
initial stage;
formed ulcer;
complications of peptic ulcer.

Peptic ulcer disease is diagnosed using an x-ray or endoscopy of the stomach. An X-ray examination should be performed if a peptic ulcer is suspected, preferably in a pre-ulcerative state. However, more often the ulcer is discovered only after the clinical picture appears. It can manifest itself as belching, heartburn, pain after eating. In severe cases, nausea and vomiting may occur.

Radiological signs of an ulcer on x-ray are:

A niche in the area of the contour of the stomach wall. A niche is the shadow of a contrast agent that has penetrated into the ulcerative defect. It can be round or oval, have various sizes (from 0.5 cm to 5 cm or more).
Uneven contour of the mucous membrane. The edges of the ulcer are pitted and uneven. They contain granulation tissue, blood, and food. However, small ulcers may have smooth edges.
Increasing the number and volume of folds. The folds are enlarged due to inflammation of the area of the wall around the ulcerative defect. When using double contrast, you can see that the folds are directed towards the ulcerative defect.
Increased secretion of gastric juice. A sign of hypersecretion is the presence in the stomach horizontal level liquid located under the gas bubble.
Local spasm of the gastric wall. Spasm occurs at the level of the ulcer, but at opposite side. It looks like a small, persistent retraction of the stomach wall.
Rapid advancement of contrast agent in the area of the ulcerative defect. This is due to the fact that, under the control of nervous and reflex mechanisms, the gastric wall tries to reduce the time of contact of the affected area with a potential irritant.

Of the listed signs of an ulcer, only a niche in the wall of the stomach is direct, and the rest are indirect. If an x-ray fails to identify a direct sign of an ulcer—a niche—then the radiologist will continue to search for it if indirect evidence of its existence is found. The niche may not appear on the x-ray because it may be filled with food or mucus. With the help of modern X-ray equipment, ulcers measuring 2–3 mm can be detected.

Complications of peptic ulcer. Cicatricial deformities of the stomach on x-ray. Cascade stomach

Peptic ulcer disease is dangerous, first of all, because of its complications. They are the outcome of almost any ulcerative defect. Even if the ulcer heals, it is replaced by a scar, which is not a full replacement for this tissue. Therefore, in the case of peptic ulcer disease, like any other, the statement is true that it is easier to prevent a disease than to treat it. Peptic ulcer disease can be prevented if you pay attention to the symptoms in time and conduct a stomach examination. Patients with peptic ulcer disease are usually registered at a dispensary and undergo preventive examinations at certain intervals, which helps prevent the development of complications.

Complications of peptic ulcer disease are:

scarring and deformation of the stomach wall;
pyloric stenosis;
gastric perforation;
penetration of ulcers into neighboring organs;
cancerous degeneration of an ulcer.

Scar deformities are the most noticeable and frequent complications peptic ulcer disease. They form at the site of long-existing ulcers. Ulcers usually have a bottom in the submucosa, which consists of connective tissue. It is from this that scar tissue develops, since the epithelium cannot completely regenerate in the area of the defect.

Today it is rare to see serious deformities on x-rays. This is due to the fact that modern methods Treatments help prevent major complications. For example, an hourglass deformity appears if scarring occurs along the circular muscle fibers with a constriction in the center of the stomach and dividing it into two parts. With minor curvature deformation, the output and initial sections are pulled towards each other. Such a stomach is called a purse-string or snail-shaped stomach.

Cascade stomach is a deformation in which a constriction is formed separating the cardiac section ( upper section) stomach from the rest. Thus, the stomach is divided into two levels ( cascade). This deformation greatly impedes the passage of food through the gastrointestinal tract and usually requires surgery to correct.

Despite the fact that massive deformations are becoming less common in modern world, small areas of scarring can be found in the stomach even in people who consider themselves healthy. This is due to the fact that the ulcer can be asymptomatic and heal on its own. On an x-ray, small stomach scars look like irregularities in the contour of the shadow of the stomach and the area where the folds converge. There are no folds in the scar area itself. In the area of the scar, the peristaltic wave is not detected or is weakened.

X-ray diagnosis of penetration and perforation of ulcers

Penetration of an ulcer is its penetration into neighboring organs. An ulcerative cavity is formed in the adjacent organ, which communicates with the stomach cavity. Penetration is always noticed by the patient and is the reason for seeking medical help. Pain that occurs when this complication, very strong and are accompanied by nausea, vomiting, weakness, even loss of consciousness.

Penetration of the ulcer into the following formations is observed:

spleen;
abdominal wall;
stomach ligaments.

X-ray reveals a large ulcerative defect in the stomach. The contours of the ulcer niche become uneven. The contrast mass penetrates beyond the stomach into the neighboring organ, where a three-layer picture is observed, consisting of barium suspension, liquid and gas. The same picture can be observed with inflammation of the gastric diverticulum. Palpation of the abdomen helps to clarify the penetration of the ulcer. In the area of penetration of the ulcerative defect into a neighboring organ, severe compaction caused by inflammation is observed.

Perforation of an ulcer is a communication between the stomach and the abdominal cavity through an ulcerative defect. In this case, free gas is detected in the abdominal cavity, which looks like a crescent-shaped clearing under the diaphragm. To detect it, it is enough to perform a survey x-ray of the abdominal cavity. Exact time The patient can indicate perforation independently, as it is accompanied by severe pain. After 2 hours, gas can already be detected in the abdominal cavity, which initially accumulates on the right side under the diaphragm. The pain of a perforated stomach ulcer is very similar to heart pain, so the perforation can be confused with a myocardial infarction, which can cost valuable time.

Diagnosis of stomach cancer at the site of an ulcerative process using x-rays

One of the main conditions for the formation of a malignant tumor is chronic inflammation. In the case of peptic ulcer it is present. The transition of an ulcer to a cancerous tumor is not so rare and accounts for about 10% in the case of large ulcers. With stomach cancer, a person’s ability to eat food significantly deteriorates, he loses weight and is exhausted. In order to avoid this, it is necessary to undergo timely treatment for peptic ulcer.

With the development of cancer, the ulcerative defect acquires the following radiological signs:

an increase in the size of the ulcer up to 3 centimeters;
uneven edges of a cancerous ulcer;
complete immobility of the stomach walls in the area of the ulcer;
formation of a shaft around the ulcer and undermined edges of the ulcer niche.

X-rays are not the most reliable way to detect cancer. Accurate diagnosis of cancer is carried out only through histological analysis of a section of gastric tissue. A piece of tissue is removed during an endoscopic examination and then examined under a microscope. The detection of atypical cells in such a study is confirmation of cancer. Oncologists treat this disease. The patient may require surgery to remove part of the stomach.

Stomach cancer on x-ray. Saucer crayfish

Gastric cancer is a malignant tumor of the gastric mucosa. It occurs quite often; bad habits of a person play a large role in the development of stomach cancer ( smoking, alcoholism), malnutrition, consumption of carcinogenic substances, smoked meats. The development of stomach cancer, as in the case of ulcers, is caused by infection with the Helicobacter bacterium. A cancerous tumor is a cluster of mutant cells that grow uncontrollably, depleting capabilities and disrupting the functioning of all organs of the body.

Stomach cancer has a variety of forms and courses. Initially, the tumor is a small island of tumor cells on the surface of the mucous membrane. It can protrude into the lumen of the stomach or be located in its thickness. Subsequently, an area of necrosis and ulceration forms in the center of the tumor. At this point, the cancerous tumor is very similar to an ulcerative defect. If cancer develops at the site of the ulcer, it will go away initial stages. In most cases, it is impossible to distinguish cancer from ulcers using x-rays. To do this it is necessary to carry out endoscopic examination. But with the help of x-rays it is possible to identify those who really need endoscopic examination ( FEGDS).
The diversity of cancerous tumors means that it is rare to see cancerous tumors that look the same on X-rays.

X-rays can be used to distinguish the following types stomach cancer:

Exophytic cancer. Protrudes into the lumen of the stomach. It looks like a deepening of the contour of the shadow of the stomach, in which there is no peristalsis. Exophytic cancer may appear as a plaque ( flat spot ) or polyp ( mushroom on a thin or wide base).
Infiltrative-ulcerative ( endophytic) cancer. In this form of cancer, part of the mucosa is destroyed, which looks like a filling defect. The contours of the defect are uneven, the folds in the tumor area are destroyed, this area does not participate in peristalsis.
Diffuse cancer. With this form of cancer, the stomach narrows evenly due to changes within its wall. The deformity is permanent, that is, the stomach does not straighten when it is full. To diagnose this type of cancer, it is necessary to examine a piece of tissue under a microscope.

A separate form of stomach cancer is saucer cancer. Such a tumor has raised edges in the form of a dense shaft, and in the center there is a small depression. An x-ray reveals a filling defect, in the center of which there is an accumulation of barium mass with uneven outlines. Saucer-shaped cancer is clearly limited by a shaft from the healthy mucous membrane, however, due to its shallow depth and small tumor size, it can be missed when studying an x-ray.

Stomach cancer first manifests itself as loss of appetite, weight loss, and aversion to meat foods. Subsequently, pain appears in upper sections abdomen, vomiting, bleeding. Almost the only way to treat stomach cancer is surgery to remove part of the gastric wall. In order to prevent the appearance of malignant tumors, you need to carefully monitor the condition of your body, especially chronic diseases such as gastritis or peptic ulcer.

Benign stomach tumors on x-ray

Benign gastric tumors are rare and are usually discovered incidentally. x-ray examination. Benign tumors consist of cells that do not differ from healthy ones and do not have mutations in the genetic material. This is the main difference between benign and malignant tumors. Benign stomach tumors grow slowly and do not cause any symptoms.

Benign tumors can be of the following types:

Epithelial. They grow in the form of polyps inside the lumen of the stomach. Whether they can be detected on x-ray depends on their size. Polyps larger than 3 mm look like depressions in the contour of a rounded contrasting mass. In this case, an expansion of one of the folds is observed, while other folds move away from it. Peristalsis is not disturbed, and the contours of this formation are smooth and clear.
Non-epithelial. They consist of muscle cells, nerve tissue or connective tissue cells. These tumors are located inside the wall of the stomach. The mucous membrane is not changed, but the folds of the mucous membrane are smoothed and flattened. The lumen of the stomach uniformly narrows by a small amount. Peristalsis is also preserved, however, with large tumor sizes, difficulties may arise with the passage of food.

Benign tumors are not a cause for concern and usually do not require treatment. However, in order to ensure the benign nature of the formations, it may be necessary additional diagnostics. It can be done using computed tomography, ultrasound examination ( Ultrasound) or endoscopy. Anyway, benign tumors require monitoring because rapid tumor growth may alter their prognosis.

Where can I get an X-ray of the stomach and esophagus?

X-rays of the stomach and esophagus can be performed at various medical institutions. The necessary equipment - an X-ray machine - can be found in private and public medical centers. Specialized medical staff works in diagnostic centers or gastroenterological hospitals. High-quality diagnostics conduct private medical clinics. The price for x-ray examination of the stomach and esophagus differs in different cities of Russia and also depends on the equipment used.

In Moscow

Clinic name

In recognizing gastritis, the main role is given to the clinical examination of the patient in combination with endoscopy and gastrobiopsy. Only by histological examination of a piece of the gastric mucosa can the shape and extent of the process and the depth of the lesion be established.

At the same time, when atrophic gastritis X-ray examination is equivalent in effectiveness and reliability to fibrogastroscopy and is second only to biopsy microscopy.

X-ray diagnostics is based on a set of radiological signs and their comparison with a complex of clinical and laboratory data. A combined assessment of the thin and folded relief and function of the stomach is mandatory.

Determining the condition of the areolas is of key importance. Normally, a fine-mesh (granular) type of fine relief is observed.

The areolas have a regular, predominantly oval shape, clearly defined, limited by shallow narrow grooves, their diameter varies from 1 to 3 mm. Chronic gastritis is characterized by nodular and especially coarse-nodular types of thin relief.

With the nodular type, the areola is irregularly rounded, 3-5 mm in size, limited by narrow but deep grooves. The coarse nodular type is distinguished by large (over 5 mm) areolas of irregular polygonal shape.

The furrows between them are widened and not always sharply differentiated.

Changes in folded relief are much less specific. In patients chronic gastritis thickening of the folds is noted.

Upon palpation, their shape changes slightly. The folds are straightened or, conversely, strongly curved; small erosions and polyp-like formations can be detected on their ridges.

At the same time, functional disorders are recorded. During the period of exacerbation of the disease, the stomach on an empty stomach contains fluid, its tone is increased, peristalsis is deepened, and spasm of the antrum may be observed.

During the period of remission, the tone of the stomach is reduced, peristalsis is weakened.

Aspects of X-ray diagnosis of gastric cancer

A perforated ulcer is detected on x-ray after studying a plain x-ray of the abdominal cavity. The detection of a crescent-shaped clearing under the right dome of the diaphragm is due to the higher position of this dome when compared with the left-sided analogue.

If FGDS does not detect a perforated defect and there is no “sickle” on the plain X-ray, a contrast X-ray of the stomach can be performed. Gastroscopy is performed under the control of an X-ray television screen. When performing the procedure, the doctor has the opportunity to monitor the condition of the stomach during the passage of contrast and stretching of the walls with gas.

Causes, signs and treatment of duodenal ulcers

Radiology plays important role in recognizing ulcers and its complications.

When performing an X-ray examination of patients with gastric and duodenal ulcers, the radiologist faces three main tasks. The first is an assessment of the morphological state of the stomach and duodenum, primarily the detection of an ulcerative defect and determination of its position, shape, size, outline, and the condition of the surrounding mucous membrane.

The second task is to study the function of the stomach and duodenum: detecting indirect signs of peptic ulcer disease, establishing the stage of the disease (exacerbation, remission) and assessing the effectiveness of conservative therapy.

The third task comes down to recognizing complications of peptic ulcer disease.

Morphological changes in peptic ulcer disease are caused by both the ulcer itself and concomitant gastroduodenitis. The signs of gastritis are described above.

A direct symptom of an ulcer is considered to be a niche. This term refers to the shadow of a contrasting mass that fills the ulcerative crater.

The silhouette of the ulcer can be seen in profile (such a niche is called a contour niche) or in full view against the background of the folds of the mucous membrane (in these cases we talk about a niche in relief, or a relief niche). The contour niche is a semicircular or pointed protrusion on the contour of the shadow of the stomach or duodenal bulb.

The size of the niche generally reflects the size of the ulcer. Small niches are indistinguishable under fluoroscopy.

To identify them, targeted radiographs of the stomach and bulb are necessary.

With double contrasting of the stomach, it is possible to recognize small superficial ulcerations - erosions. They are more often localized in the antral and prepyloric parts of the stomach and have the appearance of round or oval clearings with a pinpoint central accumulation of contrast mass.

The ulcer can be small - up to 0.3 cm in diameter, medium - up to 2 cm, large - 2-4 cm and giant - more than 4 cm. The shape of the niche can be round, oval, slit-like, linear, pointed, irregular.

The contours of small ulcers are usually smooth and clear. The outlines of large ulcers become uneven due to the development of granulation tissue, accumulations of mucus, and blood clots.

At the base of the niche, small indentations are visible, corresponding to swelling and infiltration of the mucous membrane at the edges of the ulcer.

The relief niche has a persistent round or oval accumulation of contrasting mass on the inner surface of the stomach or bulb. This accumulation is surrounded by a light structureless rim - an area of edema of the mucous membrane.

At chronic ulcer relief niche can be irregular shape with uneven outlines. Sometimes there is a convergence (convergence) of the folds of the mucous membrane towards the ulcerative defect.

Benign stomach tumors

The X-ray picture depends on the type of tumor, the stage of its development and the nature of its growth. Benign tumors of an epithelial nature (papillomas, adenomas, villous polyps) originate from the mucous membrane and protrude into the lumen of the stomach.

Initially, a structureless rounded area is found among the areolas, which can only be seen with double contrast contrast of the stomach. Then the local expansion of one of the folds is determined.

It gradually increases, taking the form of a round or slightly oblong defect. The folds of the mucous membrane bypass this defect and are not infiltrated.

The contours of the defect are smooth, sometimes wavy. The contrast mass is retained in small depressions on the surface of the tumor, creating a delicate cellular pattern. Peristalsis is not disturbed if malignant degeneration of the polyp has not occurred.

Non-epithelial benign tumors (leiomyomas, fibromas, neuromas, etc.) look completely different.

They develop mainly in the submucosal or muscular layer and extend little into the gastric cavity. The mucous membrane over the tumor is stretched, as a result of which the folds are flattened or moved apart.

Peristalsis is usually preserved. The tumor can also cause a round or oval defect with smooth contours.

X-ray criteria for stomach cancer

It is better to diagnose stomach cancer when the stomach is tightly filled with barium. When the cavity is filled with contrast, the mucous membranes are straightened, so the defect is filled well and is clearly visible in the image.

When interpreting serial radiographs obtained after gastrography, the radiologist must pay attention to different phases stomach contractions. It is advisable to record the state of the organ during the passage of a peristaltic wave.

There is a visual difference between an X-ray defect in cancer and an ulcer. Filling defect at cancerous tumor can be traced as an additional formation against the background of a gas bubble (exophytic cancer). Sometimes the sign is detected on a plain X-ray of the abdominal cavity.

Cancer forms not only a niche, but also thick walls through which the peristaltic wave does not pass. Dense tissues lead to deformation of the greater curvature of the stomach, which is visualized by tight filling.

During gastroscopy, specialists do not have the opportunity to perform a biopsy, but competent decoding in the presence of specific signs will allow specialists to identify cancer at an early stage and carry out radical treatment.

Thickening of the wall at the location of the formation; Narrowing of the organ lumen during concentric growth (symptom of “syringe”); Uneven contour of the defect with tight filling.

With an ulcer, the defect is about 4 cm wide. If the “filling defect” is visible against the background of an altered relief, the diagnosis of cancer is beyond doubt.

Modern ideas about peptic ulcer disease with localization of the ulcer in the stomach have been significantly deepened and clarified thanks to x-ray examination, which not only confirms clinical diagnosis stomach ulcer, but can provide comprehensive information about its location and size, secondary changes of a deforming nature, connections with neighboring organs, etc. Finally, x-ray examination helps to recognize an ulcer, when clinically there is often no suspicion of its presence. Such “silent” ulcers are not so rare. However, modern X-ray diagnostics with its rich technical equipment does not yet make it possible to recognize gastric ulcers in all cases without exception. As for the reliability of the radiological diagnosis of gastric ulcer, it is very high and, according to surgical comparisons, reaches 95-97%.

X-ray signs of a gastric ulcer can be divided into two groups: 1) indirect, indirect signs characterizing functional disorders in the ulcer and 2) anatomical, direct signs, which include: ulcer niche, accompanying the ulcer reactive changes from the mucous membrane and cicatricial deformities.

Indirect signs, which are indicators of functional disorders, are of little importance for establishing the diagnosis of gastric ulcer. Changes in tone, evacuation, secretion, as well as pain sensitivity are not pathognomonic for ulcers and occur in many diseases of the abdominal cavity.

Peristalsis in gastric ulcers is often increased, especially when the ulcer is localized at the pylorus or in the duodenal bulb. However, peristalsis often retains a “quiet” type and is even weakened, so it is not possible to evaluate the nature of peristalsis as one of the signs contributing to the diagnosis due to insufficient reliability. Peristalsis may weaken or even completely disappear at the very site of ulceration. This is especially clear on polygrams, in which there is a lack of crossover of peristalsis due to infiltration and rigidity of the stomach wall. However, this must be treated with a critical assessment, since the same nature of peristalsis can also affect the so-called “minor forms” of stomach cancer.

Evacuation delays are common. But this is not the rule, and it is often necessary to note very rapid emptying of the stomach even with such ulcers that are detected on the basis of direct symptoms.

A particularly important place among the indirect signs of the ulcerative process is occupied by local spasm of the circular muscles of the stomach. This symptom manifests itself in the form of deep retraction along the greater curvature (De Quervain's symptom). Often, opposite such retraction, an ulcerative niche is observed along the lesser curvature.

Pain sensitivity is of great importance in determining an ulcer, but the value of this sign is weakened by the fact that very often patients either do not notice pain sensitivity, or the pain point is found outside the stomach, for the most part in the solar plexus area.

To establish a diagnosis of gastric ulcer based on indirect symptoms, the entire symptom complex of functional disorders may be important.

Although not sufficiently diagnostically valuable, indirect signs become of great importance during repeated radiological observations in cases of ulcers established on the basis of anatomical changes. Accounting for functional deviations in X-ray picture for gastric ulcers, it makes it possible to correctly assess the dynamics of the disease under the influence of the therapy chosen for the patient.

Direct signs. The main radiological symptom of a gastric ulcer is the so-called niche (Fig. 86). The niche corresponds to an anatomical disruption of the integrity of the stomach wall and usually has a crater-shaped shape. This is a barium depot at the site of a tissue defect. Thus, “minus tissue” is radiographically expressed as “plus shadows.” Superficial, flat ulcers that do not have a more or less deep bottom, the so-called “niches on the relief,” are especially difficult to recognize, since the anatomical disorders in them are expressed to a small extent.

Rice. 86. Stomach ulcer (x-ray).
a - niche along the lesser curvature with convergence of the mucosa; b - niche along the lesser curvature with a shaft of edematous mucosa.

Diagnosis of an ulcerative niche is facilitated by the fact that it is accompanied by changes in the relief of the mucous membrane. At a niche you can often observe the convergence of folds, or their so-called convergence. A ring-shaped ridge forms around the ulcer, protruding above the surface of the mucosa. This cushion occurs due to infiltration of the mucous membrane, which contributes to the deepening of the ulcerative crater. Thus, the depth of the niche depends not only on the degree of destruction of the stomach wall, but also on the protrusion of the mucosal shaft above it. Therefore, the depth of the niche often does not correspond to the depth of the wall defect. The shaft itself surrounding the ulcer, called the “ulcer shaft,” is an expression of swelling of the mucous membrane and functional changes of a spastic nature on the part of the muscles of the submucosal layer. This shaft has an important diagnostic value and not only helps to identify the niche, but makes it possible to evaluate the evolution of the ulcerative process with repeated studies. Often there is a picture in which the reaction from the mucous membrane becomes pronounced. Then the swelling of the mucous membrane leads to the formation of a massive shaft that closes the entrance to the ulcerative defect - a crater, which makes it difficult to diagnose the ulcer during the initial examination. Only subsequently, as such a reactive process subsides, can a niche be clearly identified.

There are often cases when, with the appropriate clinical symptom complex and in the presence of pronounced changes in the mucous membrane in the form of significant swelling and deformation of the relief, the initial study fails to identify a niche. When improving general condition studied or after anti-edematous preparation, after a few days the niche becomes clearly visible.

With an ulcer, there is also infiltration of the walls of the stomach, often reaching large sizes and sometimes even palpable under the screen in the form of some swelling.

Changes in the mucosa become important when they are localized in the antrum. It is here that we most often observe the emergence of a niche during the decline of the jet
swelling of the mucous membrane. IN in some cases the small niche found during initial testing becomes larger with clinical improvement. This “paradoxical dynamics” of the niche (S.V. Reinberg, I.M. Yakhnich, G.A. Gusterin, B.M. Stern) is observed with a decrease in edema around the ulcer and indicates a favorable course of the process.

Great difficulties arise when identifying prepyloric and, especially, pyloric ulcers. However, now ulcers of this localization are detected quite often (Fig. 87). Ulcers along the greater curvature of the body of the stomach are most rarely recognized and difficult to differentiate, especially with severe symptoms of mucosal edema. But even here, the typical picture of changes in the relief of the mucous membrane in the form of convergence of folds provides significant assistance in the diagnosis of these ulcers. Often a large niche is separated from its “maternal” base, separated by a narrow isthmus, sometimes reaching a considerable length. This most often occurs when penetrating ulcers or covered perforations, but can also be caused by inflammatory infiltrative changes in the edges of the ulcer. A niche that has a spur-like shape or the shape of a sharp thorn is characteristic of an ulcer accompanied by pronounced perigastric changes.

Rice. 87. Stomach ulcer (x-ray).

The arrow indicates the gatekeeper's niche.

In some cases, such a sharply manifested infiltration can be observed around the ulcer that small filling defects are formed due to the contrast mass flowing around these protrusions of the stomach walls and folds of the mucosa. In this case, the niche takes on a scalloped appearance with uneven and sometimes unclear contours. Similar large niches with these changes are very suspicious for the presence of malignant transition, especially if they are located in the subcardial or antrum (Gutman, 1950; Massa, 1958). Patients with such niches require very careful clinical and radiological observation so that surgical treatment can be undertaken in a timely manner.

X-ray examination, repeated during the treatment of patients, makes it possible to make a judgment about the effectiveness of the treatment used and about the reverse development of the ulcer based on changes in its main feature - the niche. Reduction in niche size as a result of proper treatment is common. It should be taken into account that such a decrease may depend not only on the direct influence therapeutic measures on the ulcer in general. Reducing the size of a niche may also be associated with an improvement in the functional background. Manifestations of “paradoxical dynamics” may also occur. Therefore, a decrease in the niche does not yet indicate a tendency to cure the ulcer.

In the process of monitoring the results of treatment and assessing its effectiveness, the study of changes in the relief of the mucous membrane becomes of great importance. If, during dynamic observation, a decrease in the accompanying edema is detected before a decrease in the size of the niche is detected, then in similar cases positive treatment effects can be expected.

Before making a diagnosis of gastric ulcer, the patient should visit several doctors. The disease can be diagnosed after a visit to a therapist, endoscopist, experienced surgeon, or laboratory assistant. In this case, various research methods are used (for example, gastroscopy), which make it possible to recognize the disease and determine the most effective methods of treatment and prevent complications in time.

Patient Interview

The patient should be asked in detail about his state of health in order to obtain information about complaints that often indicate ulcers and other diseases of the gastrointestinal tract. When a peptic ulcer occurs, the pathology can be recognized depending on the symptoms that the patient complains about. The main symptoms are pain and dyspeptic syndrome. The specialist should be alert to symptoms that appear regularly. Patients claim that they feel sick and feel painful sensations, heaviness, severe heartburn. Before making a diagnosis, the doctor must make sure where exactly the pain is located.

Then you need to find out when painful sensations appear (at night or in the morning), their nature and frequency. It is necessary to take into account the dependence of these symptoms on food consumption, the influence that the number of dishes and their consistency have on the occurrence of such manifestations. You also need to take into account such a sign as the appearance of attacks after a certain time that has passed after eating. In this case, food can alleviate existing symptoms, pain can be associated with physical activity, working conditions, nervous overstrain, injuries. You should find out how the painful sensations spread, whether they radiate to other parts of the body.

Physical examination

The technique is applied during the patient’s first visit to the doctor. The physician must listen carefully to the patient's complaints. After this, the specialist begins a medical examination. Often health problems can be suspected if a person’s color changes skin. The abdomen should then be shown to the patient so that the doctor can feel it. Through palpation, it is possible to establish what the boundaries and outlines of organs are and to identify possible deviations from the norm. After this, the physician performs percussion of the gastrointestinal tract. Percussion can identify many diseases. A preliminary study allows us to characterize the general condition of the patient. If necessary, the therapist refers the patient to other specialists and prescribes tests that will help create a more complete picture.

X-rays allow a thorough examination of the gastrointestinal tract.

X-ray examinations allow a thorough examination of the gastrointestinal tract. The procedure is carried out using special devices that allow one or another organ to be displayed on a small screen. You can take pictures using film. The X-ray examination method allows you to evaluate the structure of the intestines and stomach. The accuracy of the results reaches 80 percent. Using this technique, we examine:

pharynx;
parts of the stomach;
esophagus;
diaphragm.

Most often, x-rays are prescribed to patients suffering from the following manifestations:

dysphagia;
discomfort in the stomach;
gagging;
anemia;
weight loss;
attacks of pain;
the presence of seals inside the stomach;
detection of occult blood in tests;
disruptions in the functioning of the stomach.

There are several examination methods: traditional x-ray and other types (for example, emergency contrast). For peptic ulcers, x-rays are effective when using the 2nd contrast method (a contrast agent is used). Using x-rays, doctors study the motility of the gastrointestinal tract and compensatory function.

Diagnosis of stomach ulcers allows you to select correct treatment which will prevent complications from occurring.

Endoscopic examination

The endoscopic method is considered the most reliable, since it allows you to confirm/refute the ulcer, its location, outline, size and monitor the healing of affected tissues, and evaluate the effectiveness of treatment. The endoscopic technique helps to identify minor changes in the structure of the mucous membrane of the abdominal cavity and duodenum, and to cover areas in the stomach that are inaccessible to x-rays. In addition, it is possible to obtain the mucous membrane of the edge-forming area of the ulcer through the use of a biopsy to conduct a more detailed study of the tissue structure.

Ulcer of the stomach and duodenum due to the common pathogenesis of morphological and clinical manifestations are considered as a single disease - peptic ulcer.

X-ray examination plays an extremely important role in recognizing peptic ulcer disease. Recognition of peptic ulcer disease is based on both direct radiological signs of an ulcer and indirect ones.

Direct radiological signs of peptic ulcer.

The main direct sign of an ulcer is “niche”. A niche is a limited protrusion on the silhouette of the stomach filled with a contrast agent. The niche appears as a result of the ulcerative defect in the stomach wall being filled with a contrast agent. The niche represents something additional, additional to the wall of the stomach, an additional shadow, + shadow.

If the niche is located on the front or back wall, it can be expressed as a spot on the relief of the mucous membrane - “a niche on the relief”. Around the niche there is a pronounced marginal inflammatory shaft due to swelling of the mucous membrane. The dimensions of the niche vary depending on the degree of destruction of the wall and the size of the inflammatory shaft. The inflammatory shaft can lengthen the niche, and sometimes it can be expressed so sharply that it closes the entrance to the niche. The niche can be filled with food, a blood clot, or mucus. Therefore, in some cases the niche is not detected radiographically.

In chronic recurrent or callous ulcers, a restructuring of the mucosal relief is often detected in the form of convergence of folds towards a niche. This restructuring is caused by scar changes. Convergence of folds and an inflammatory shaft are also direct signs of an ulcer.

Niches can be small, medium and large in size. Niche acute ulcer in case of a recent disease, determined during the first study, usually measures 0.5 x 0.8 cm. Small niches the size of a pea are more often found in the duodenal bulb.

The most common niches are of average size 0.5 - 0.8 x 1.0 - 1.2 cm.

A large ulcer niche, the diameter and depth of which is several centimeters, is usually observed in emaciated people, with a long history of the disease with a pronounced clinical picture. Such niches are usually found in penetrating ulcers.

Penetrating niche- this is a deep niche that penetrates beyond the wall of the stomach into some other organ. Such a niche is often three-layered - barium, liquid, air, or two-layered - barium and air. The presence of an air bubble in a niche always indicates penetration. The ulcer niche usually has smooth walls. The unevenness of the walls indicates either bleeding or the degeneration of an ulcer into cancer.

Indirect signs of peptic ulcer disease.

Indirect signs of peptic ulcer disease are mainly functional changes. These include:

1. Increased gastric tone, which is expressed in slow expansion of the stomach.

2. Enhanced peristalsis– the presence of deep waves, sometimes peristaltic waves lace the stomach into separate segments.

3. Hypersecretion - the presence of fluid in the stomach on an empty stomach.

4. Delayed evacuation - due to spasm of the pylorus during a pyloric ulcer of the stomach. But sometimes with stomach ulcers, faster evacuation may be observed.

5. Pain points in a certain area of the stomach shadow in combination with other indirect signs that often indicate the presence of an ulcer.

Stomach cancer.

In the domestic literature, in the description of x-ray semiotics of all known forms of cancer of the stomach, the works of such authors as Yu.N. Sokolova, A.I. Ruderman (1947); Yu.N. Sokolova and P.V. Vlasova (1968) and others.

Currently, a classification of pathological forms of developed gastric cancer is used (Sokolova Yu. N., 1965)

1. Exophytic cancer

a. Knotted:

i. In the form of cauliflower

ii. Polypoid

iii. Mushroom

b. Cup-shaped:

i. With retained shaft

ii. With a destroyed shaft

c. Plaque-shaped:

i. No ulceration

ii. With ulceration