A Study of Antral Gastritis in the Resected Stomach

Abstract

It has been a controversial matter whether a relationship exists between chronic gastritis and gastric or duodenal ulcer. As long as50 years ago, Nauverk believed that gastritis precedes and predisposes to the development of ulcer. But it was Konjetzny 6 who demonstrated with his extensive histologic observa­ tions on the freshly fixed resected parts of the gastric wall that the occurrence of gastritis in ulcer patients is a regular finding not only in the proximal part of the antrum but also extending to the distal part. Konjetzny 6 has emphasized that the histologic study of the stomach which is resected by the surgeon offers an incontrovertible proof for the preoperative condition of the mucosa because the tissues are absolutely fresh and not SUbjected to postmortem changes. Based on the fact that gastritic changes were found in 100 per cent of the cases operated on for chronic ulcer, he put forward the theory that chronic peptic ulcer in man starts either as an erosion or as an acute ulcer and that a primary break in the epithelial surface is therefore a conditio sine qua non for a chronic ulcer. From the experimental point of view the cinchophen ulcer may be considered an original example of how a chronic ulcer can develop from a diffuse focal gastritis and become evident within 24 hours after the first dose of the drug. The findings of Konjetzny were confirmed later by the gastroscopic obselva­ tions of Schindler and Sielmann,8 Henning,4 Gutzeit,3 and others. They found hemorrhagic erosions or mucosal hemorrhages in 44 per cent of the cases examined as compared to an incidence of 5.8 per cent in cases without ulcer. These lesions occurred in the areas of the stomach in which the ulcer was present. During recent years several investigators, particularly from North .-\merica (Bockus,2 Benedict,' Selesnick, and Kinsella 7 ) were not able to confirm the findings of Konjetzny. Schindler, Necheles and Gold 9 have proposed the idea, based on animal experiments, that the gastritis of the resected stomach is a surgical one produced by the relatively slow deprivation of blood of the stomach during the subtotal gastrectomy. More recently Henning and associates5 have demonstrated that the histo­ logic appearance of fragments of mucosa which were removed by passing a Wood's biopsy tube into the stomach of ulcer patients was normal. In only 4 out of 34 patients with duodenal ulcer were signs of acute or chronic gas