Some Late Effects of Gastro-Enterostomy Performed for the Relief of Peptic Ulcer

A WRITER, recently reviewing the known facts of the etiology of peptic ulcer, comments on the well-known observation that it is found in that part of the gastrointestinal tract that is directly exposed to gastric juice, and is subjected to the greatest mechanical stress by the passage of the gastric contents.1 Another established fact is the frequent association of ulcer with hyperchlorhydria, in from sixty to eighty-five per cent. of duodenal cases,2 3 and about thirty per cent. of gastric.3 Achloryhydria is rare in either form of ulcer, and achylia gastrica believed to be unknown.3 The importance of an excess of free HC1 in the genesis of an ulcer has been illustrated by the experiments of Mann and Bollman,4 Matthews and Dragenstedt,5 and others. The former found that experimental jejunal ulcers were produced in about twenty per cent. of dogs after gastro-jejunostomy, when the bile and pancreatic juice had free access to the loop of jejunum used in the anastomosis. When, however, these juices were diverted and drained into the ileum and only gastric juice allowed into the loop, a jejunal ulcer developed in ninety-five per cent. of cases. Chronic gastric ulcers were also produced in dogs by the instillation of dilute HC1 (0.4 per cent.) through a fistula for several hours in the day. These ulcers tended to heal if the acid was discontinued, but became chronic if it was resumed. The effects of a rich secretion of gastric juice on an empty stomach has been shown by Buechner,6 who produced ulcers in starved rats by repeated injections of histamine. The trend of these experiments is, therefore, to assign an important r6le to the acid of the gastric juice in the formation and chronicity of ulcer, and to show that its effect can be mitigated by the neutralizing action of the alkaline duodenal juices and by the presence of food in the stomach.