Giant gastric ulcer

Summary 1. The authors' experience in 27 cases of giant gastric ulcers (craters larger than 3 cm. in diameter) is presented.2. In 8 patients, the diagnosis of malignancy was made before treatment was begun. Four proved to have malignant ulcers, and the other 4 benign ones.3. Of the 18 patients submitted to the therapeutic test, 5 healed their lesions after 8 weeks and the remainder after 2 and a half, 5, and 13 months, respectively.4. The only serious complication was hemorrhage.5. Pulmonary chronic emphysema was found in 6 patients.6. The authors believe that the large size of these ulcers is not a criterion of malignancy, and that these giant lesions may heal as well as the smaller ones, although they show an increased tendency to recurrence.7. The authors emphasize the importance of the so-called pseudotumoral gastric ulcer, which roentgenologically and/or gastroscopically, as well as macroscopically, has the appearance of an ulcerated cancer. The benign nature of the lesion is revealed only by histologic study. Four patients were inadvertently submitted to extensive surgery, and 3 died as a result of their operations.The studies described in this article were supported by grants from Jayme Torres and the Jockey Club of São Paulo.     

History of Helicobacter pylori,duodenal ulcer,gastric ulcer and gastric cancer

Helicobacter pylori(H.pylori)infection underlies gastric ulcer disease,gastric cancer and duodenal ulcer disease.The disease expression reflects the pattern and extent of gastritis/gastric atrophy(i.e.,duodenal ulcer with non-atrophic and gastric ulcer and gastric cancer with atrophic gastritis).Gastric and duodenal ulcers and gastric cancer have been known for thousands of years.Ulcers are generally non-fatal and until the 20th century were difficult to diagnose.However,the presence and pattern of gastritis in past civilizations can be deduced based on the diseases present.It has been suggested that gastric ulcer and duodenal ulcer both arose or became more frequent in Europe in the 19th century.Here,we show that gastric cancer and gastric ulcer were present throughout the 17th to 19th centuries consistent with atrophic gastritis being the predominant pattern,as it proved to be when it could be examined directly in the late 19th century.The environment before the 20th century favored acquisition of H.pylori infection and atrophic gastritis(e.g.,poor sanitation and standards of living,seasonal diets poor in fresh fruits and vegetables,especially in winter,vitamin deficiencies,and frequent febrile infections in childhood).The latter part of the 19th century saw improvements in standards of living,sanitation,and diets with a corresponding decrease in rate of development of atrophic gastritis allowing duodenal ulcers to become more prominent.In the early 20th century physician’s believed they could diagnose ulcers clinically and that the diagnosis required hospitalization for"surgical disease"or for"Sippy"diets.We show that while H.pylori remained common and virulent in Europe and the United States,environmental changes resulted in changes of the pattern of gastritis producing a change in the manifestations of H.pylori infections and subsequently to a rapid decline in transmission and a rapid decline in all H.pylori-related diseases.     

Cytomegalovirus-associated gastric ulcer.

A patients with a cytomegalovirus (CMV) post-transfusion syndrome developed upper gastrointestinal tract bleeding; subsequently, a gastric ulcer was found. CMV was searched for in the gastroscopic biopsy material because the gastric ulcer had occurred in a setting of CMV mononucleosis. CMV cells were found in gastroscopic biopsy sections and CMV was also cultured from biopsy material. This study illustrates the feasibility of antemortem diagnosis of CMV-associated disease of the upper gastrointestinal tract.     

Trichobezoar and gastric ulcer

Summary The presence of trichobezoar in the stomach may be associated with ulceration, and complications such as hemorrhage and perforation may occur in these patients. Although it is important for the radiologist to establish the diagnosis of bezoar in the stomach, the radiographic attempt to localize possible ulcerations is of even greater importance as far as immediate care is concerned.Mechanical, traumatic, and chemical factors due to the presence of the foreign body in the stomach enter into the production of these ulcers. Therefore, their prompt removal is indicated, and one can confidently expect relief of symptoms and healing of the ulceration.Trichobezoar with gastric ulceration, if not discovered, may produce severe symptoms and complications leading to death.