The therapeutic control of acid secretion in gastric ulcer: a critical appraisal

Abstract

Gastric ulcer is characterized by a wide range of acid secretory patterns in relation to the site of the niche inside the stomach. Studies performed with continuous 24 h intragastric pH monitoring have shown that ulcers located at or above the angulus have significantly less acid than those located in antral or prepyloric regions and this difference is particularly evident during the night. These findings confirm that acid is of less importance in the pathogenesis of the former sub-group. Thus, the failure of mucosal defence seems to predominate in proximal gastric ulcers, while acid secretion of distal gastric ulcers is similar to that of duodenal ulcers and therefore aggressive factors seem to be more important in them. Although antisecretory drugs are the mainstay of peptic ulcer therapy, a more adequate correction of the pathophysiological alterations which characterize the different locations of gastric ulcer should be called for. In clinical trials assessing the efficacy of potent acid inhibitors it seems relevant to make a clear-cut distinction between proximal and distal ulcers inside the stomach because these 2 subgroups probably benefit in a different way from the same antisecretory treatment. In particular, a profound suppression of acid secretion does not seem to be necessary to heal gastric body ulcers which are frequently associated with chronic gastritis and disruption of oxyntic cells.