lining resulting from the crater of the ulcer, focal interruption of mucosal enhancement resulting from the ulcer crater eroding through the epithelial lining of the mucosal layer into the submucosal layer or muscularis propria) and neutral oral contrast such as water or dilute barium suspension (positive oral contrast can impede assessment of mucosal enhancement and preclude assessment of intraluminal bleeding) [12]. There is limited value of performing a CT abdomen without and with IV contrast for this indication. A CT examination without IV contrast may help in diagnosing PUD by detecting findings such as extraluminal gas, reactive fluid, fat stranding along the gastroduodenal region, ascites, focal wall defect, or a large ulcer. However, the addition of IV contrast significantly improves conspicuity of findings, such as interrupted mucosal enhancement and bowel wall hyperenhancement, making the CT examination more sensitive in diagnosis. CT Abdomen Multiphase Multiphase contrast-enhanced examinations are not routinely performed in patients with suspected acid reflux, esophagitis, gastritis, peptic ulcer, or duodenal ulcer, but a CT angiographic protocol, including precontrast, arterial, and portal venous phases or a 2-phase dual-energy protocol with arterial and portal venous phases, may be used for patients with suspected acute gastrointestinal (GI) bleeding. These protocols may be used if GI bleeding as a complication of PUD is suspected [12]; otherwise, there would be limited utility of a multiphase examination. FDG-PET/CT Skull Base to Mid-Thigh Although patients with GERD and esophagitis may exhibit increased radiotracer uptake in the distal esophagus on fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)-PET [13], there is no relevant literature to support the use of FDG- PET/CT in the prospective diagnosis of acid reflux, esophagitis, gastritis, peptic ulcer, or duodenal ulcer.
Epigastric Pain. lining resulting from the crater of the ulcer, focal interruption of mucosal enhancement resulting from the ulcer crater eroding through the epithelial lining of the mucosal layer into the submucosal layer or muscularis propria) and neutral oral contrast such as water or dilute barium suspension (positive oral contrast can impede assessment of mucosal enhancement and preclude assessment of intraluminal bleeding) [12]. There is limited value of performing a CT abdomen without and with IV contrast for this indication. A CT examination without IV contrast may help in diagnosing PUD by detecting findings such as extraluminal gas, reactive fluid, fat stranding along the gastroduodenal region, ascites, focal wall defect, or a large ulcer. However, the addition of IV contrast significantly improves conspicuity of findings, such as interrupted mucosal enhancement and bowel wall hyperenhancement, making the CT examination more sensitive in diagnosis. CT Abdomen Multiphase Multiphase contrast-enhanced examinations are not routinely performed in patients with suspected acid reflux, esophagitis, gastritis, peptic ulcer, or duodenal ulcer, but a CT angiographic protocol, including precontrast, arterial, and portal venous phases or a 2-phase dual-energy protocol with arterial and portal venous phases, may be used for patients with suspected acute gastrointestinal (GI) bleeding. These protocols may be used if GI bleeding as a complication of PUD is suspected [12]; otherwise, there would be limited utility of a multiphase examination. FDG-PET/CT Skull Base to Mid-Thigh Although patients with GERD and esophagitis may exhibit increased radiotracer uptake in the distal esophagus on fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)-PET [13], there is no relevant literature to support the use of FDG- PET/CT in the prospective diagnosis of acid reflux, esophagitis, gastritis, peptic ulcer, or duodenal ulcer.