Bleeding Peptic Ulcer Caused by Ectopic Gastric Mucosa in a Duplicated Segment of Jejunum

The authors present a case in which a patient suffered a bleeding jejunal ulcer caused by heterotopic gastric mucosa in a congenital duplication of a segment of jejunum. This is the first case diagnosed preoperatively by two different radiographic means. These lesions were shown by both pertechnetate flow and barium small bowel studies. The rarity of these entities and the modalities used for diagnosis are described.     

Effect of Ranitidine and Cimetidine on Gastric Ulcer Healing and Recurrence

Fifty-eight patients with endoscopically confirmed benign gastric ulceration were randomly allocated to treatment with 150 mg ranitidine twice daily, placebo matching ranitidine twice daily, or 200 mg Cimetidine three times daily and 400 mg at night. Patients were endoscoped at monthly intervals for up to 3 months, the endoscopist being unaware of the treatment. Significantly more ulcers (p < 0.05) had healed after 2 months of ranitidine (14 of 18, 78%) and Cimetidine (17 of 20, 85%) than with placebo (9 of 20, 45%; P < 0.05) and after 3 months of ranitidine (15 of 18, 88%) and Cimetidine (18 of 20, 90%) than with placebo (11 of 20, 55%; p < 0.05). Forty-eight patients with healed ulcers were randomly allocated in a double-blind prophylactic study to recieve 150 mg ranitidine at night or matching placebo. After 6 months recurrent ulcers were found in 2 of 24 (8%) of patients receiving ranitidine and 10 of 24 (42%) of patients receiving placebo (p < 0.05). These data indicate that H₂-receptor antagonists are significantly better than placebo in healing gastric ulceration and that ranitidine and Cimetidine are equally effective. Ranitidine is significantly superior to placebo in preventing gastric ulcer recurrence.     

消化性溃疡患者胃排空功能的初步观察

本文对正常人,十二指肠溃疡,胃溃疡患者共66例,用锝~(99)标记的液体试餐,于服用后5分钟、10分钟分别检测胃的排空率及半排空时间。结果显示,无论是早期相的5分钟和10分钟的液体排空速度还是半排空时间,溃疡病患者组与正常对照相比,均未显示差异。没有排空加速或迟缓的表现。由此推论,在治疗中应用与胃的运动有影响的药物(如多潘立酮,颠茄等),并无实际意义.     

消化性溃疡,胃癌患者胃窦粘膜中胃肠激素含量变化及其意义

研究了胃十二指肠疾病患者胃窦粘膜胃泌素（Ｇａｓ）、生长抑素（ＳＳ）、Ｐ－物质（ＳＰ）的含量变化及其意义。结果表明：胃窦粘膜ＳＳ含量在胃溃疡组低于其余各组（Ｐ均〈０．０５），而在胃癌时则显著增高（Ｐ〈０．００１）；ＳＰ浓度在十二指肠溃疡组显著低于其余各组（Ｐ均〈０．０５）；胃癌患者Ｇａｓ水平显著高于对照组（Ｐ〈０．０５）；ＳＳ与ＳＰ在十二指肠溃时呈明显负相关。提示：胃粘膜中Ｇａｓ、ＳＳ、ＳＰ的含量变     

Gastric Ulcer Healing with Ranitidine and Cimetidine

A single-blind study of 339 patients in 19 centres compared the efficacy and tolerance of ranitidine in treating endoscopically confirmed gastric ulcers. Ranitidine (150 mg twice daily) was compared with cimetidine (1 g daily in divided doses) over 4 weeks, followed by a second 4-week treatment for any patient whose ulcer was not healed. In 292 patients who completed the study, endoscopy showed healing in 69% of patients receiving ranitidine and 59% receiving cimetidine after 4 weeks, and 90% and 88%, respectively, by 8 weeks. These results were not significantly different, and, similarly, healing rates for different ulcer sites did not differ. There were no serious adverse drug reactions during the study. Ranitidine is an effective and safe treatment for healing gastric ulcers, with a tendency to produce a faster healing rate than cimetidine during the first 4 weeks of treatment.     

短程低剂量三联疗法对胃粘膜保护作用的随机双盲对照研究

目的：观察短程低剂量“新三联”对消化性溃疡的胃粘膜保护作用并探讨其可能的机制。     

胃肠粘膜内皮素-1与消化性溃疡的关系

为探讨胃肠粘膜内皮素-1(ET-1)在消化性溃疡发生中的作用,作者应用放射免疫测定法测定了对照组(慢性浅表性胃炎)(10例)、胃溃疡(28例)和十二指肠溃疡(13例)粘膜内ET-1的浓度。结果显示:胃溃疡活动期粘膜内ET-1浓度(7.37±2.90 pg/mg)高于对照组(4.45±1.70 pg/mg)和胃溃疡愈合期(5.64±1.05 pg/mg)(P<0.01,P<0.05),与十二指肠溃疡活动期(6.85±3.37 pg/mg)之间无显著性差异(P>0.5)。愈合期胃溃疡粘膜内ET-1浓度与对照组之间无显著性差异(P>0.01)。不同程度的活动期消化性溃疡粘膜内ET-1浓度之间亦无显著性差异(P>0.2)。结果提示胃肠粘膜内ET-1与消化性溃疡关系密切,可能在消化性溃疡的发病机制中起着重要作用。     

消化性溃疡中胃粘膜病变的特点分析

分析４９１例消化性溃疡伴随胃溃膜病变的特点。结果：性别年龄因素对病变发生率无影响。粘膜炎症较之萎缩和溃疡关系更密切。十二指溃肥广泛粘膜炎症及体部慢性轻度炎症为特点；胃溃疡以广泛萎缩，窦部重度萎缩及重度慢性活动性炎症为特点。两者粘膜病变特点和现有关于两者发病机理的认识相吻合。     

Effect of Carbenoxolone on Ionic Fluxes across Normal Gastric Mucosa and that Associated with Gastric Ulcer*

Summary: The effect of carbenoxolone on ionic permeability of human gastric mucosa was determined using liquid test meals in five healthy subjects. Control solutions contained 160 mM HCI and 25 μc/litre ⁵¹CrCl₃ as non-absorbable indicator. The test solution contained in addition 100 mg carbenoxolone per 200 ml. No significant differences were found in net H ⁺, Na ⁺, K ⁺, or Cl^- fluxes between control and carbenoxolone studies. In three subjects studies were repeated after three weeks of oral therapy with carbenoxolone tablets 100 mg tid. This produced no significant alteration of values either in control or carbenoxolone studies. A 24 year old patient with a markedly abnormal gastric mucosal barrier was studied during the acute phase of his ulcer and again after radiological healing of the ulcer following three months therapy with carbenoxolone 100 mg tid. Ionic permeability of the mucosa remained unaltered despite healing of the ulcer and/or carbenoxolone therapy. When the ulcer recurred intragastric instillation of the carbenoxolone test solution failed to alter ionic permeability. We conclude that carbenoxolone does not alter ionic permeability in normal subjects nor does its action in increasing the healing rate of gastric ulcer appear to be due to alteration of ionic permeability.     

Regional Differences on Production of Chemokines in Gastric Mucosa Between Helicobacter pylori-Positive Duodenal Ulcer and Gastric Ulcer

It is well known that antrum-predominantgastritis and pan-gastritis occurs in the patients withHelicobacter pylori-positive duodenal ulcer (DU) andgastric ulcer (GU), respectively. However, the role of chemokines in the pathogenesis of thesepathologies is unclear. We examined the regionaldifferences in mucosal chemokine production in patientswith DU and GU. The production of interleukin-8 (IL-8), growth-related gene (GRO) , andmacrophage inflammatory protein (MIP)-1 wasgreater in the antrum than in the corpus in DU patients.In the patients with GU, monocyte chemoattractantprotein (MCP)-1 levels in the mucosa adjacent to ulcer weregreater than those away for the ulcer in the corpus. Thereduction in chemokine production occurring inassociation with the eradication of H. pylori differed between DU and GU patients in the antrum (IL-8,P = 0.0394; GRO, P = 0.0149; MIP-1, P =0.0246; MCP-1, P = 0.0087). The data imply a differentpathogenesis may exist for the gastritis present in patients with DU and GU occurring in H.pylori-positive individuals.     

Distribution of Collagen Types I,III, and IV in Peptic Ulcer and Normal Gastric Mucosa in Man

The quality of peptic ulcer healing does not only mean complete epithelial restitution of the mucosal surface but also adequate repair of the underlying connective tissue. To obtain more information about the metabolism of extracellular matrix proteins in gastric mucosa and submucosa, we investigated biopsy specimens from six patients with antral peptic ulcers and six normal controls by staining of collagen types I, III, and IV with an immunofluorescence technique. In normal mucosa we found a certain amount of collagen types I and III in equal distribution and almost no collagen type IV. In contrast, there was a remarkable increase of collagen types I and III in peptic ulcers predominantly located at the ulcer edges. These results are compatible with the view that extracellular matrix proteins play some part in the ulcer healing process.     

Factors Influencing the Healing Rate of Gastric Ulcer under Treatment with Cimetidine

Factors influencing the healing rate were evaluated by multivariate analysis on 148 patients with gastric ulcer who were under treatment with cimetidine at a daily dose of 800 mg. Factors used were age, sex, therapeutic environment, duration of present ulcer pain, past history of gastric ulcer, the amount of tobacco, alcohol, and coffee consumed before and during the treatment, the period until symptoms disappeared after the commencement of the treatment, and the characteristics of the ulcers themselves. Of these factors, the five factors that had a significant delaying effect on the healing of gastric ulcers were: 1) having a past history of gastric ulcers, 2) symptoms not disappearing within 1 wk after the commencement of the treatment, 3) size over 20 mm, 4) ulcer located in an angle, and 5) round or oval shape of the ulcer. The patients with less than one of the unfavorable factors (n = 36) had the best healing rate (97.2%), compared with those with two (n = 61), three (n = 39), or four or more (n = 12) unfavorable factors. The healing rate of the latter three groups was 75.4%, 53.8%, and 33.3%, respectively (p less than 0.01). Thus, a prognostic score based on these five factors represents the severity of gastric ulcers with regard to the healing in patients prescribed cimetidine.     

The Peptic Gastric Ulcer — Histotopographic and Functional Investigations

Histotopographic studies of approximately 200 gastric ulcers using endoscopic biopsies show that the chronic gastric ulcer is found in mucosa containing only mucoid or intestinal glands. Furthermore, with few exceptions (prepyloric ulcer), this mucosa is usually inflamed. Since the ulcer is nearly always found at the border to the acid-producing mucosa, the localization is an indication of the extent of gastritis and of the maximal acid secretion capacity of the stomach. In patients with a gastric ulcer, normal body or antrum mucosa is found more rarely than in a corresponding control group.     

Gastric Biopsy in Peptic Ulcer: A Follow-up Study

Fundal biopsy was performed in 155 peptic ulcer patients (GU 65, DU 90) and antral in 43 (GU 17, DU 26) of the 155 patients. In GU fundal gastritis was found in 74 and antral in 94 % of the cases. In DU the percentages were 16 and 65 respectively. In a short-term follow-up of 30 patients (GU 15, DU 15) the state of the fundal macosa remained essentially unchanged in 19, became worse in 6, and possibly showed an improvement in 5. In a 1–6 year follow-up of 58 patients (GU 28, DU 30) the same type of mucosal structure was preserved in 40, worsening of the changes in 13, and some improvement in 5.     

Observations on Blood Group Distribution in Peptic Ulcer and Gastric Cancer

There is increasing evidence that blood group substances play a rôle in the causation of disease or in the protective mechanism against it. This paper records the special liability for patients of blood group O to develop stomal ulceration. Other data studied failed to confirm previous work suggesting that in gastric ulceration or neoplasm blood group A was a characteristic of an antral lesion.     

幽门螺杆菌相关性消化性溃疡的细胞凋亡研究

目的：探讨幽门螺杆菌（Helicobacter pylori,HP)诱导胃上皮细胞凋亡的机制及细胞凋亡在HP相关性消化性溃疡（PU）中的作用。方法：内镜下胃粘膜活检取材,应用TUNEL法检测胃上皮细胞凋亡,免疫组化法检测凋亡调控蛋白bak、bcl-2的表达。结果：HP阳性胃溃疡（GU）和十二指肠（DU）患者细胞凋亡指数（AI）明显高于HP阴性非溃疡性消化不良（NUD）患者（P＜0．01）。根除HP后,AI在DU明显下降（P＜0．01）,在GU无明显改变（P＞0．05）。HP阳性DU溃疡活动期AI明显高于愈合期和瘢痕期（P＜0．05）,而HP阳性和GU溃疡三期AI无差异（P＞0．05）。bak蛋白表达在HP阳性PU明显高于HP阴性NUD患者（P＜0．05）。根除HP后,DU患者bak蛋白表达明显降低（P＜0．05）。GU患者虽有下降,但无统计学差异。bcl-2蛋白表达在HP阳性PU与HP阴性NUD之间无显著差异,HP根除前后亦无明显改变。结论：HP诱导胃上皮细胞凋亡在十二指肠溃疡发病中起重要的作用,HP诱导胃上皮细胞凋亡可能是通过bak路径实现的。     

Effect of Enprostil on Omeprazole-Induced Hypergastrinemia and Inhibition of Gastric Acid Secretion in Peptic Ulcer Patients

This study was performed to examine the effectsof additional enprostil administration onhypergastrinemia and gastric acid suppression induced byomeprazole. Serum gastrin concentrations were measured in 10 peptic ulcer patients (six Helicobacterpylori-positive and four Helicobacter pylori-negativepatients) before treatment, after two weeks ofomeprazole (20 mg/day), and after two weeks ofomeprazole and enprostil (50 g/day). The additionalacid inhibitory effect of enprostil was evaluated by24-hr intragastric pH measurements in five healthyHelicobacter pylori-negative volunteers. Afteromeprazole treatment, the serum gastrin level ofHelicobacter pylori-positive patients (3.5-fold ofcontrol) was markedly higher than that of Helicobacterpylori-negative patients (1.7-fold of control).Additional treatment with enprostil suppressed serumgastrin levels to 0.4-fold and 0.7-fold of omeprazoletreatment levels in Helicobacter pylori-positive andHelicobacter pylori-negative patients, respectively. In healthy volunteers, median pH recordedduring the nonmeal daytime interval increasedsignificantly with additional enprostil. Thus, enprostilreduces undesirable omeprazole-induced hypergastrinemia, especially in Helicobacter pylori-positivepatients, and effectively suppresses acidsecretion.