Gastric Ulcers with and without Associated Duodenal Ulcer Have Different Pathophysiology

Abstract

1. Maximal acid output after pentagastrin stimulation, and fasting and postprandial serum gastrin concentrations were determined in 25 normal subjects, 30 patients with corpus gastric ulcers, 10 patients with prepyloric ulcers and 30 patients with both duodenal and gastric ulcers. 2. Corpus ulcers and prepyloric ulcers formed one distinct group. Maximal acid output was abnormally low in the corpus ulcer patients and no different from normal in prepyloric ulcer patients, whereas fasting serum gastrin and postprandial integrated gastrin response was abnormally high in the former and no different from the normal in the latter. Furthermore, as in the normal subjects, a significant negative correlation between maximal acid output expressed in mmol h(-1) kg(-1) body weight and postprandial integrated gastrin response was observed in the corpus and prepyloric ulcer patients taken as a group. 3. In complete contrast patients with both duodenal and gastric ulcers, in whom postprandial integrated gastrin response was statistically highest amongst the three types of gastric ulcers, had a significantly positive correlation between maximal acid output and the integrated gastrin response. 4. These findings suggest the operation of different pathophysiological mechanisms in gastric ulcers with and without associated duodenal ulcers.

Profound spatial clustering of simultaneous peptic ulcers.

“…For this test ulcer locations were divided into five ordered regions: proximal stomach (location 1-25), antrum (26)(27)(28)(29)(30)(31)(32)(33)(34)(35), pyloric region (36-40), proximal duodenal bulb (41-45) and distal duodenal bulb (46-50). For each patient the number of ulcers at each site were calculated.…”

Recurrence after proximal gastric vagotomy for gastric, pyloric, and prepyloric ulcers

“…Pathophysiologically and genetically, this type of combined ulcer disease is a separate entity [26]. Patients with combined ulcers have a positive correlation of gastric acid output and gastrin response [46]. It, therefore, seems logical to remove the antrum as a possible pathophysiological factor.…”

Μεταβολες Της Γαστρινης Του Ορου Και Του Πληθυσμου Των G- Και D-Κυτταρων Του Αντρου Και Του Δωδεκαδακτυλου Μετα Απο Χορηγηση Κορτικοστεροειδων Σε Ινδικα Χοιριδια. (Πειραματικη Ραδιοανοσολογικη Και Ανοσοκυτταροχημικη Μελετη)

“…120 μεταξύ τώ βασικών τιμών της γαστρίνης και τής βασικής έκκρισης τοΰ γαστρικοϋ υγρού. Ή πιθανή ερ μηνεία τοΰ φαινομένου αυτού είναι είτε ή διαφορετική άπο άτομο σε άτομο ευαισθησία τών καλυπτηρίων κυττάρων στην ενδογενή γαστρίνη 379 εϊτε ή ύ'παρξη ανάστροφης λειτουργικής καί ανατομικής σχέσης μεταξύ ττίς μάζας των καλυπτηρίων καί των G-κυττάρων 197 , 200 , 379 .…”