Factors affecting depth of gastric ulcers

We investigated the differences in background factors, clinical features, and gastric function tests among gastric ulcers of various depths.

The subjects were 68 patients (male 64, female 4) who were diagnosed as having a gastric ulcer at the angulus. The ulcers were classified according to depth based on the following: UL2 (shallow) ulceration to the submucosa; UL3 (intermediate), to the muscularis propria; and UL4 (deep excavation), beyond the muscularis propria. The depth of each ulcer was determined by endoscopic ultrasonography and/or ordinary endoscopic findings. We assessed clinical features, age, gender, smoking habit, alcohol consumption, ulcer history, presence of H. pylori, gastric acid secretion, gastric emptying, serum gastrin level, healing rate, and recurrence rate.

Patients with UL4-type ulcers had a higher rate of recurrence and a significantly higher incidence of H. pylori infection. Patients with hyperacidity and currently smoking or consuming alcohol were significantly more likely to have UL4-type ulcers than of UL2 or 3 ulcers. Furthermore, a close relationship was recognized between recurrence, intractability and deeply excavated ulcers. Ulcer depth was not correlated significantly with any of the following factors: 1) patient's profile; including gender and hemorrhagic symptoms; 2) gastric function; including gastric emptying and serum gastrin levels.

Smoking, alcohol consumption, recurrence of ulcers, hyperacidity and H. pylori infections are important factors associated with deep ulcers.