An investigation of stomach and duodenal ulcer based on pathomorphological data for ten years.
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Ninety patients with perforations and hemorrhaging duodenal ulcers were examined. It was established that the intragastric pH-metry in patients with acute complications of the ulcer disease allowed to approximately estimate the acid formation in the stomach and the completeness of vagotomy just in the course of urgent operations. The acid forming function of the stomach can be changed in 21,3% of the patients within the nearest 6 months.
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The term "peptic ulcer" is used freely in relationship to both gastric and duodenal ulcers, but the ulcer in the stomach has clinical significance vastly different from that of the duodenal ulcer. A duodenal ulcer is considered primarily a benign medical disease, and it is associated with high gastric acid and peptic activity. The ulcer located in the stomach, however, has a definite malignant potential. It is often associated with normal or low gastric acidity, and is more frequently a surgical lesion. The coexistence of both gastric and duodenal ulcers ranges from 2.7% to 9%.10,11,13 The general interest in carcinoma of the stomach and its association with gastric ulcer is a source of constant discussion, but it is surprising how sparsely the literature is dotted with references to the coexistence of carcinoma of the stomach and duodenal ulcer. Bockus1stated that "... patients with marked gastric hyperchlorhydria and hypersecretion
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In 332 patients of adenocarcinoma of the stomach and 7095 patients with duodenal ulcer collected in 5-year period, 21 cases were found to have both disease entities. With regard to clinical manifestations, gross morphology, microscopic differentiation and management of adenocarcinoma of the stomach, the patients with duodenal ulcer showed no significant difference from those without duodenal ulcer. The activities of the duodenal ulcers could be in acute active stage or present as chronic scar only. The ulcer history varied from several years to more than 15 years. We concluded that the frequency of adenocarcinoma of the stomach developed in patients with duodenal ulcer is not so rare, presentation of epigastric discomfort or signs of UGI bleeding in patients with duodenal ulcer history not always indicated recurrence of ulcer disease.
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Antisecretory effect of intravenous quamatel (Q) and gastrocepin (G) was studied in 59 patients with duodenal ulcer. Mean maximal pH and delta-pH in antral portion of the stomach and its body were similar for Q and G, but pH responded to Q administration faster. The antisecretory effect of Q was more pronounced in males and young patients and was inversely proportional to initial acidity.
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Alteration in gastric emptying has been implicated in duodenal ulcer disease. The precise abnormalities remain controversial. We have used a radionuclide technique to assess solid and liquid gastric emptying in 14 patients with endoscopically proven duodenal ulcer and 22 healthy controls. Solid gastric emptying values for the patient group fell within the normal range. The median time taken for 50% (T50) of the liquid marker to empty from the stomach was 12 minutes (range 6-23 minutes) which was significantly faster (p less than .005) than controls (median 18 minutes, range 11-35). In 10 of the 14 patients, however, the rate of liquid emptying was within the normal range. There was no significant difference in the T50 for gastric emptying of solids between the groups, but in duodenal ulcer patients food left the stomach significantly earlier than in controls (p less than .05). After this, however, the linear rate at which duodenal ulcer patients emptied solid food from the stomach was a median 0.75%/minutes (range 0.5-1.4 minutes), which was slower (p less than .0005) than controls, median 1.25/minutes (range 0.7-2.3). These results show that the pattern of gastric emptying of digestible solids and liquids in patients with duodenal ulcer disease, as a group, is significantly altered.
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Of 182 examined patients with the stomach and duodenum ulcer disease (UD) 104 (57.14%) of whom with complications. Antiulcerous antibodies were determined in patients according to results obtained in passive hemagglutination reaction (PHAR) using erythrocytic diagnosticums. In patients with gastric and duodenal UD the antitissue antibodies to corresponding antigens from gastric and duodenal ulcers were determined before the operation. The incidence of antibodies discovery depends on the patients condition. In 18 months after the operation the percentage of PHAR positive results have reduced down to 72.5% on average.
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There were examined 79 patients, operated on for duodenal ulcer disease. Before the operation the Helicobacter pylori (HP) dissemination of stomach and duodenum of significant degree was diagnosed in 51.9%, mild degree--in 34.2% and of a nonsignificant one--in 13.9% of patients. After the operation the HP dissemination of stomach and duodenum had persisted.
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