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Gastric ulcer and regurgitation gastritis.

1970; BMJ; Volume: 11; Issue: 8 Linguagem: Inglês

10.1136/gut.11.8.715

1468-3288

John P. Delaney, Jinjun Cheng, B A Butler, Wallace P. Ritchie,

Helicobacter pylori-related gastroenterology studies

Progress reportGastric ulcer and regurgitation gastritis Experimental and clinical data have incriminated excess gastric acid secretion as an important factor in the development of duodenal ulcer.On the other hand, gastric ulcer is characteristically associated with normal to low levels of acid secretion, and mucosal resistance factors have been invoked to explain the pathogenesis.The purpose of this report is to summarize the evidence favouring the hypothesis that regurgitation of duodenal contents into the stomach causes gastritis and an attendant decrease in mucosal resistance to ulceration.Recent experimental results from our laboratory support this propo-sition1' 2 , 4 The concept of regurgitation gastritis is not original with us but has received inadequate attention.Four lines of evidence favour the proposed hypothesis.(1) Gastric ulcer is invariably accompanied by gastritis.(2) Individuals with gastric ulcer have greater than normal regurgitation of duodenal contents into the stomach.(3) Exposure of normal gastric mucosa to intestinal contents leads to gastritis.(4) Gastritis increases the susceptibility of the mucosa to ulcer formation. Gastric Ulcer and GastritisCruveilhier,5 in 1862, pointed out the association of gastric ulcer and atrophic gastritis.Konjetzny6 observed that gastric ulcer is invariably surrounded by inflammatory changes, and noted further that the mucosa in an ulcer- bearing stomach is diffusely abnormal.He proposed the dictum that gastric ulcer never develops in normal mucosa.Magnus7 correlated gastroscopic and histological appearances of stomachs removed for treatment of peptic ulceration.Thirty per cent of the specimens excised for gastric ulcer had diffuse gastritic changes in the body mucosa.None of the stomachs resected for duodenal ulcer demonstrated such an abnormality.Hebbel8 made a thorough study of the relationship of chronic gastritis to gastric ulcer.Of 15 resected stomachs, 12 demonstrated moderate to severe gastritis involving the entire antrum in addition to the immediate region of the ulcer.The diffuse distribution of histological changes suggested to him that gastritis was a primary process rather than the result of the ulcer.Stomachs seen at necropsy from subjects with no known gastric or duodenal disease showed gastritic changes in only 18% of specimens.Guiss and on July 11, 2023 by guest.