Concepts on Acute Gastric Mucosal Lesions: Surgical Viewpoints Masaki Kitajima 1 , Tatsuo Kiuchi 1 , Noritaka Sakai 1 , Sadamu Shinkawa 1 1The First Department of Surgery, School of Medicine, Kyorin University pp.619-628
Published Date 1989/6/25
DOI https://doi.org/10.11477/mf.1403106472
  • Abstract
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 Acute gastric mucosal lesions (AGML) are a wellrecognized complication of a variety of diseases, including surgery, drug inducement and stress. Several conceptual explanations have been proposed, i.e., gastric acid hypersecretion and destruction of defensive factors of the gastric mucosa.

 But these concepts on AGML is not always consistent in pathophysiology, diagnosis and management. The purpose of this study is to elucidate the most recent concept on AGML with special reference to pathophysiology and management from the viewpoints of surgery. Recently, the focus of studies on the development of AGML has shifted gradually from the balance between aggressive and defensive mechanisms of the gastric mucosa to reperfusion injury following ischemic change of the gastric mucosa. Change of CoQ10 anion radical and SOD level in gastric mucosa, produced by clamping caeliac axis by mini-clip in rats led to the development of AGML. However, it is extremely difficult to elucidate the pathophysiological mechanism of AGML on clinical and experimental bases because of various causative factors involved.

 AGML in general is considered to develop suddenly presenting with gastric symptoms and acute gastric lesions. These gastric lesions are endoscopically observed as acute erosive gastritis, acute ulcer and hemorrhagic gastritis. Most of them improve by conservative management with H2 receptor antagonist and secretins. But in some, conservative management being ineffective, such surgical treatments as selective vagotomy and wide resection of the stomach become mandatory. Accordingly, comparative studies were experimentally performed to elucidate reasonable and physiological procedures in conservative and surgical managements. Conservative management with H2 receptor antagonist was demonstrated to be more effective than surgical management for AGML. H2 receptor antagonist had a pronounced inhibitory effect on acid secretion. In addition, it was found to maintain and improve local blood flow in the gastric mucosa. In contrast, vagotomy performed with the intention to decrease acid secretion, in fact, proved ineffective in maintaining blood flow under stressful situation. These results indicate that gastric defensive mechanism is destructed after vagotomy.

 Based on these results,(near) total gastrectomy, instead of vagotomy, is considered treatment of choice for bleeding AGML.

Copyright © 1989, Igaku-Shoin Ltd. All rights reserved.


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