Diagnosis

The Scar Solution Natural Scar Removal

Scar Solution By Sean Lowry

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Endoscopic diagnostic criteria (Figs. 3.87, 3.88)

The endoscopic appearance of an ulcer depends on its stage. Three stages are distinguished: active, healing, and scar:

- Round, oval, linear

- Bizarre shape

- Punched-out appearance

- Usually < 1cm (Caution: easy to overestimate true ulcer size; measure with an open biopsy forceps!)

- Inflammatory swelling of the ulcer margin

- Ulcer base below the level of the surrounding mucosa

- Fibrin coating

- Greenish, yellowish, whitish

- Hematin

- Visible vessel: dark spot 1-2 mm in size

► Healing stage

- Ulcer margin flatter and more irregular

- Hyperemic mucosa grows from periphery to center

- Fibrin coating on the ulcer base

- Reddish mucosa covering the ulcer base

- Light spot

- Atrophic mucosa

- Folds radiating toward the scar

Differential diagnosis

Crohn disease

► Boeck disease

► Eosinophilic gastritis

► Amyloidosis

Checklist for endoscopic evaluation

► Location: prepyloric, antrum, angulus, body, fundus, lesser curvature, greater curvature, anterior wall, posterior wall

► Size: novices tend to overestimate ulcer size. Estimate size with an open biopsy forceps.

► Shape: round, oval, linear, bizarre, irregular

► Ulcer margin: flat, raised

► Ulcer base: fresh blood, hematin, fibrin, visible vessel

► Assess need for endoscopic treatment. Stages I-IIa should be treated (see p. 145 f.).

Fig. 3.87 Gastric ulcer b Ulcer in the antrum c Ulcer with an undermined margin a Ulcer located just proximal to the pylorus

Fig. 3.87 Gastric ulcer b Ulcer in the antrum c Ulcer with an undermined margin a Ulcer located just proximal to the pylorus

Additional Studies

- Ulcer margin: one specimen per quadrant

- Ulcer base: one specimen per quadrant

- Ulcer center: one specimen

- Histological examination

- Rapid urease test

- Breath test

- Serological testing

- Culture method

► Radiography: Precede endoscopy with abdominal plain film if perforation is suspected.

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