Duodenal Ulcer Group Research Articles

Epidemiology and course of gastrointestinal haemorrhage in North-east Scotland.

A prospective study was made of 817 consecutive episodes of major gastrointestinal haemorrhage in patients admitted to hospital during 1967-8 from the defined population of North-East Scotland. The yearly admission rate was 116 per 100,000 population. Comparison of the data for city and country residents showed no appreciable differences. In the duodenal ulcer group there was an undue incidence of bleeding among foremen and skilled workers and among those who were unmarried or widowed.Both the clinical history and the results of any previous barium meal examinations were unreliable guides to the source of the current haemorrhage. Prognosis was worse for patients who did not have a dyspeptic history and was better for those who had bled on a previous occasion. The simultaneous ingestion of alcohol and aspirin had an adverse effect on the occurrence of bleeding. Forty-seven per cent. of the patients had another major coincidental disease.Mortality was 13.7% in the whole series and 8.6% in those with peptic ulcer (duodenal ulcer 7.1%, gastric ulcer 16.9%). In 28% of the patients further haemorrhage occurred after admission to hospital and caused a 28.8% mortality. Seventy-four patients were already in hospital when they first bled and 44% of them died.

Histology of gastric carcinoma occurring after gastric surgery for benign conditions.

Eighty-four gastric cancers in patients who had previously been subjected to gastric surgery for benign conditions were histologically classified according to Lauren's method and compared to gastric cancers in patients with no previous gastric surgery. Apart from the absence of sarcomas among the patients previously operated on, there was little difference in the distribution of histologic types among patients previously operated on and not operated on. However, in males previously operated on, the proportion of intestinaltype tumors did not show the expected increase with age. Nor did we observe the increase in intestinal-to-diffuse ratio that might have been expected from the location of the tumors and from the association between duodenal ulcer and blood groups and between blood groups and tumor histology. I t is concluded that intestinal and diffuse types of gastric carcinoma both increase in frequency after gastric surgery, but the increase appears to be larger for the diffuse type. Intestinal metaplasia and gastritis were no more prominent in sections from the primary resectates from 16 patients who later developed gastric cancer than in controls. Infiltration of leukocytes was more prominent in carcinomas found in postoperative patients than in carcinomas found in patients not previously operated on.

Glucose tolerance and insulin secretion in patients with chronic duodenal ulcer.

An oral glucose tolerance test has been used to compare carbohydrate metabolism in patients suffering from chronic duodenal ulceration with that in a matched group of normal subjects. A significantly greater rise in blood glucose concentration was observed in the duodenal ulcer group, and this was associated with a significantly greater output of insulin. The reason for these findings may be an abnormal secretion of one or more of the small-bowel hormones.

Acid-Base Parameters of Duodenal Contents in Man

Aspirations of duodenal contents were made anaerobically in 57 subjects 10 cm distal to the pylorus after a liquid test meal. Of these, 25 subjects were considered to be normal in the upper, part of the gastrointestinal tract. In 15 subjects a duodenal ulcer was found. All except 14 of the normal subjects had a pentagastrin test. The aspirated samples were analyzed for p H and P co2 ; and the bicarbonate concentration was calculated from the Henderson-Hasselbalch equation. In the control group, variations of pH and P co2 with time were insignificant around a mean pH of 6.2 and a mean P co2 of 280 mm Hg. In the duodenal ulcer group, the p H was significantly lower ( P = 0.003) in the early postprandial period and the P co2 , was significantly higher (480 mm Hg) 2 hr after the meal ( P = 0.004). The high P co2 implies that, even though the p H is on the acid side of the usual neutral point of p H 7, a surplus of base is found in the contents as illustrated by the calculated bicarbonate concentrations, varying around 10 mEq per liter. The pH of the contents aspirated 1 hr after the meal and the P co2 measured 2 1/2 hr after the meal were correlated to the basal gastric acid secretion and to the peak acid output to pentagastrin. A significant negative correlation was found between duodenal pH and both basal gastric acid secretion and peak acid output to pentagastrin ( P co2 and basal gastric acid secretion ( P P

Serum gastrin in duodenal ulcer. I. Basal levels and effect of food and atropine.

Fasting serum gastrin has been measured by radioimmunoassay in 72 patients with duodenal ulcer and compared with that in normals, patients with gastric ulcer, and with the Zollinger-Ellison syndrome. The mean (+/- SEM) gastrin levels were 15.7 +/- 1.5 pg/ml in the duodenal ulcer group, 32.1 +/- 4.3 pg/ml in normals, 118 +/- 18.1 pg/ml in gastric ulcer, and between 450 and 2,000 pg/ml in the Zollinger-Ellison syndrome. There were no difficulties in distinguishing simple ulcer from the Zollinger-Ellison syndrome as the presence of hyperchlorhydria in combination with hypergastrinaemia led to a confident diagnosis of the latter disease.The effect of protein, glucose, and cream feeding with and without atropine was also assessed in a group of these patients with duodenal ulcer. As in normals, there was no stimulation of gastrin release by either atropine alone, distilled water, glucose, or cream. However, protein alone produced a greater rise in serum gastrin levels compared with that in normals and prior atropinization augmented this response greatly in duodenal ulcer. This indicates an increased amount of releasable gastrin in the latter disease, the release of which, under basal conditions, is suppressed by the high acidity in the antrum.

Observations on gastric acid output by a three-hour histamine infusion test using maximal doses on patients with duodenal ulcer and in normal controls.

The results of a series of histamine infusion tests extended over a period of three hours in 100 patients with duodenal ulcer and in 30 normal controls showed that while in the former group acid secretion continued to rise hourly both quantitatively and qualitatively throughout each of the three-hour periods of the tests, this did not occur in the normal controls in whom acid secretion levelled off during the second hour. Assay of 30-minute aspirates in the duodenal ulcer group showed that the 90-120 minute specimen (doubled) gave a close approximation to the values obtained during the third hour and represents maximal acid secretion of the gastric mucosa.

Relation between duodenal ulcer and blood group in people of the Udaipur region of India.

Relation between duodenal ulcer and blood group in people of the Udaipur region of India.