## Most Common Site of Gastric Ulcer **Key Point:** The lesser curvature of the stomach is the most common site for gastric ulcers, accounting for approximately 60–70% of all gastric ulcers. ### Anatomical Basis The lesser curvature has a precarious blood supply derived from the left gastric artery. This area is more prone to ischemia and acid-pepsin injury, making it the preferential site for ulcer formation. ### Distribution of Gastric Ulcers by Site | Site | Frequency | Characteristics | | --- | --- | --- | | **Lesser curvature** | 60–70% | Most common; associated with H. pylori and NSAIDs | | Greater curvature | 10–15% | Rare; often associated with severe acid hypersecretion | | Anterior wall | 5–10% | Can erode into gastroduodenal artery (bleeding risk) | | Fundus | <5% | Uncommon; usually in severe acid hypersecretion states | ### Clinical Significance **High-Yield:** Lesser curvature ulcers are the classic presentation in both H. pylori infection and NSAID-induced peptic ulcer disease. **Clinical Pearl:** The anterior wall of the stomach, though less common as a primary ulcer site, is clinically important because erosion here can lead to perforation into the peritoneal cavity, presenting as acute peritonitis. ### Mechanism The lesser curvature's vulnerable blood supply and its location in the acid-secreting region of the stomach make it susceptible to both acid-pepsin attack and ischemic injury. [cite:Harrison 21e Ch 297]
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