The analysis of gastric ulcer by endoscopical observation

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1. The patients with gastric ulcer that came under the attention of the Kanto Rosai Hospital during the past two and a half years were 160, 115 being males and 45 females, thus a sex ratio of 2.6 : 1. The peak incidence of the disease was noted in the 4th to 5th decade of life. 2. Examination at serial time intervals of 67 cases of active-phase ulcer found 48 cases (71.6%) shifting to endoscopic cicatricial phase within three months. 3. plotting the time as the ordinate and the dura-tion of clinical course as the abscissa and connecting the active phase A1 with 3 manths, a right triangle is formed. The cases outside the triangle may possibly be defined as indicated for surgery. 4. Defining an endoscopic exacerbation at the same site as recrudescence and an endoscopic discovery of a fresh developmeet of ulcer more or less deviating from the center as relapse, recrudescence was found in 19 (31.7%) of 60 cases. including recrudescence within 6 months in 17 cases (89.5%) . Relapse, within 2 months, was observed in 19 (31.7%) of 60 cases. Putting recrudescence and relapse together, exacerbation of var-ying degreess was observed in 38 (63.3%) of 60 cases in two years. 5. While recrudescence was observed in 35 (29.7%) of 35 cases, the time phase of recrudescence was C in 13 ulcers (37.1%) and B3 in 8 (22.9%), totalling 60%; and B1 in 3 ulcers (8.1%) and B2 in 5 (17.1%), totalling 8 ulcers. Incidence of recrudescence at B1 and B2 in the course towards healing was low, and incidence of recrudescence at practically healed B3 and cicatricial C was higher. 6. Positional relationship of the relapsed to the initial ulcer in 39 cases was: proximal, including adja-cent, relapse in 28 (72%) of 39 cases; in the remaining 11 cases (28%), relapse took place on the distal cardiac side. 7. Summarized location of active-phase ulcers was as follows. The ulcelation tended to be observed from the pyloric vestibulum to gastric angle in the first and second decade of life, from the gastric angle to the lower body of the stomach in the third and fourth becade, from the lower to middle body of the stomach in the fifth and sixth decade, and in the upper body of the stomach in the seventh decade. Thus, the incie-ence of ulcer on the rostral side increased with age. Examination of the cases not in line with the above tendency (i. e. active-phase ulcer on the pyloric side in cases of advanced age) found all to be ulcerative rela-pse at the adjacent side. 8. The temperature of the cicatrix of gastric ulcer was measured to the accuracy of 1/100°C, and was divided into three types. Recruscence was found not in Type, I, frequent (40%) in Type, III, and intermed-iate (27%) in Type. II, Pathological biopsy findings obtained at the same time indicated the incidence of congestion including interstitial cell infiltration, edema, and capillary hyperplasia to be high in Type, III, low in Type, I, and intermediate in Type. II. By the studies above narrated, the following conc-lusion seems to be justified : the incidence of gastric ulcer is observed at the increasingly upper position of thet stomach with age of the patient ; ulcers not in line wih this tendency are relapsed ones, with a nearby cicatrix. The cicatrix itself may be considered occasion-ally to have a great influence on the development of a relapsed ulcer.

The analysis of gastric ulcer by endoscopical observation

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