SOLITARY ULCERS IN REFLUX ESOPHAGITIS - RADIOGRAPHIC FINDINGS

Background: Some patients with reflux esophagitis have solitary ulcers in the distal esophagus. This study was undertaken to characterize fu rther the radiographic features of these ulcers and to determine wheth er or not they have a predisposition to develop on the posterior esoph ageal wall. Methods: Radiologic files and teaching files at our univer sity hospital and affiliated Veterans Administration hospital revealed 29 patients with solitary reflux-induced ulcers. The radiographs were reviewed retrospectively to determine the size and location of the ul cers as well as the presence or absence of other findings. Results: Tw enty ulcers (69%) were located on the posterior wall, five (17%) on th e left or right lateral wall, and four (14%) on the anterior wall. All but two ulcers were located 1-4 cm from the gastroesophageal junction . All of the ulcers were less than 10 mm in width and 5 mm in depth. O ther associated findings included hiatal hernias in 11 patients (38%), mucosal nodularity or granularity in 12 (41%), one or more tiny satel lite ulcers in three (10%), esophageal intramural pseudodiverticula in three (10%), an inflammatory esophagogastric polyp in one (3%), and s carring or stricture formation in 12 (41%). Conclusion: Our findings s uggest that solitary reflux-induced ulcers tend to occur on the poster ior wall of the distal esophagus near the gastroesophageal junction, p roducing characteristic radiographic findings. We postulate that affec ted individuals sleep primarily in the supine position, so that reflux ed acid pools on the dependent or posterior esophageal wall, causing m aximal injury in this location.