Chronological Evaluation of Histologic Changes in the Healing of Benign Gastric Ulcers:Morphologic Indicators of the age of the Ulcer

Histologic changes in the healing process of gastric ulcers were studied in relation to their age, i.e., the time period between the onset of an ulcer and gastrectomy. Observation was made in 27 stomachs with 31 oval ulcers or scars. Newly formed glands occurring in the regenerative mucosa with a tufty configuration, tended to occur at an ulcer age of one month or more. The regenerative mucosa regained a normal histologic appearance in 3 months. Histologic features of the submucosal fibrosis surrounding the ulcer also sequentially changed after the ulcer's onset: initially from edematous fibrosis with activated fibroblasts (F1), through dense and tight fibrosis (F2), and finally to thin and loose fibrosis (F3). F1-, F2-, and F3fibrosis approximately indicated an ulcer age of one month or less, one to 12 months, and one year or more, respectively. In the healing process of deep ulcers involving the muscularis propria, the muscularis mucosae fused together with the muscularis propria at the ulcer margin between 1.2 and 5.4 months after the ulcer's onset. The state of submucosal fibrosis surrounding the ulcer, presence or absence of the fusion of the two muscle layers at the ulcer margin, as well as the features of the regenerative epithelium covering the ulcer base are considered reliable histologic indicators of the age of a gastric ulcer.