Fractional gastric analysis in 200 cases of duodenal ulcer

The Possible Role of Bicarbonate in Mucosal Protection and Peptic Ulceration

“…The association between duodenal ulcer ation and increased acid secretion is well known [4], However, the question of why increased gastric acid produces duodenal rather than gastric ulcers remains unan swered. The duodenum, in contrast to the stomach, is a bicarbonate-rich environment where the acid contents of the stomach have to be neutralized ( fig.…”

“…However, we are no closer to an explanation than Hollander's [1] proposal that an ulcer is the result of an imbalance between the diges tive action of acid-pepsin and mucosal de fences. This general statement of the problem can only be regarded as a preliminary to the full explanation of why, for example, gastric ulcers are associated with hypoacidity [2] and occur in non-acid-secreting mucosa [3] or why hypersecretion of acid produces duode nal ulcers [4], We appear to be even further away from an explanation of why ulcers usually occur singly and as rounded, welldemarcated lesions which involve the full thickness of the gut wall. Details are available on secretory' alterations but there is a paucity of information on mucosal defence mecha nisms.…”