Refractory Gastric Ulcers-lts Pathophysiology Focused on Gastric Mucosa Hiroko Nebiki 1 , Tetsuo Arakawa 1 , Kenzo Kobayashi 1 1The Third Department of Internal Medicine, Osaka City University Medical School Keyword: 難治性潰瘍 , Helicobacter pylori , 胃酸分泌 , prostaglandin , プロトン pp.299-305
Published Date 1993/3/25
DOI https://doi.org/10.11477/mf.1403106117
  • Abstract
  • Look Inside

 Of 127 patients with gastric ulcer treated with H2-receptor antagonists (H2RAs),26% were refractory to the treatment. Computer analysis for percentage of regenerated gland area per regenerated mucosa showed less glands in the rim of the H2RA-refractory ulcers than in that of the H2RA-tractable ulcers (good responders). Sixty percent of patients with H2RA-refractory gastric ulcers were infected with Helicobacter pylori. The percentage was the same as that was found in H2RA-tractable ulcer patients, suggesting no association of this bacterium with the refractoriness. H2RAs did not raise intraluminal pH as expected in half of the patients with refractory ulcers. In these cases, ulcers healed by treatment with an H2RA continued for the next 3 months (slow responders). Contrary to expectations, continuous treatment did not affect ulcers of the other half (non-responders) in whom H2RA raised luminal pH. Prostaglandin (PG) E2 levels were lower in the ulcer rim of the nonresponders than in that of the good responders. A PG analogue administered together with an H2RA healed ulcers of the non-responders by 60%, suggesting that the reduced PGE2, in part, causes the refractoriness. A proton-pump inhibitor (PPI) healed the ulcers by 88% because of its strong effect on acid suppression overcoming the effect of H2RA. However, the higher intraluminal acidity itself may not cause the refractoriness for the reason that similar acidity was observed in patients with H2RA-refractory ulcers.

 These results shows that morphological and functional disorder of the gastric mucosa is involved in the pathophysiology of H2RA-refractory gastric ulcers.

Copyright © 1993, Igaku-Shoin Ltd. All rights reserved.


電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院