A 52-year-old man from Delhi presents with chronic epigastric pain and a history of NSAID use for arthritis. Endoscopy reveals a gastric ulcer. Which is the most common site of peptic ulcer disease in the stomach?

Question

Accepted Answer

A. Lesser curvature along the angularis. ## Anatomical Distribution of Gastric Ulcers

**Key Point:** The lesser curvature of the stomach, particularly along the angularis (angular notch), is the most common site for gastric ulcers, accounting for approximately 60–70% of gastric ulcers.

### Why the Lesser Curvature?

1. **Vascular anatomy**: The lesser curvature is supplied by the left gastric artery, which has relatively poor collateral circulation compared to the greater curvature.
2. **Acid exposure**: The lesser curvature is the most dependent area when the stomach is upright, leading to prolonged acid contact.
3. **Reduced mucus protection**: This region has thinner mucus layers and fewer mucus-secreting glands compared to the fundus.

### Comparison of Gastric Ulcer Sites

| Site | Frequency | Key Feature |
|------|-----------|-------------|
| Lesser curvature (angularis) | 60–70% | Most common; poor collateral blood supply |
| Fundus | 10–15% | Associated with Zollinger-Ellison syndrome |
| Greater curvature | 5–10% | Rare; excellent blood supply |
| Cardia | <5% | Very rare; proximal location |

**Clinical Pearl:** Gastric ulcers on the lesser curvature are more prone to perforation and hemorrhage due to proximity to the left gastric artery. They also carry a higher malignancy risk and require surveillance endoscopy to exclude gastric cancer.

**High-Yield:** In contrast, duodenal ulcers occur almost exclusively in the first part of the duodenum (D1), typically on the anterior or posterior wall, with the posterior wall being more common (due to erosion into the gastroduodenal artery, causing hemorrhage).

**Mnemonic:** **ANGEL** — Angularis is the most common site for gastric ulcers (Angularis, Nodular, Greater curvature, Esophagus, Lesser curvature — but LESSER CURVATURE at the angularis is #1).

Answer

B. Fundus

Answer

C. Cardia

Answer

D. Greater curvature

A 52-year-old man from Delhi presents with chronic epigastric pain and a history of NSAID use for arthritis. Endoscopy reveals a gastric ulcer. Which is the most common site of peptic ulcer disease in the stomach?

Explanation

Anatomical Distribution of Gastric Ulcers

Why the Lesser Curvature?

Comparison of Gastric Ulcer Sites

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Site	Frequency	Key Feature
Lesser curvature (angularis)	60–70%	Most common; poor collateral blood supply
Fundus	10–15%	Associated with Zollinger-Ellison syndrome
Greater curvature	5–10%	Rare; excellent blood supply
Cardia	<5%	Very rare; proximal location