["High" and "low" gastric ulcers in posthelicobacterial era--is this division vital?]

Area of Science:

• Gastroenterology
• Internal Medicine
• Pathophysiology

Background:

• Gastric ulcer disease (GUD) is a common condition with varying etiopathogenetic characteristics.
• Understanding these differences is crucial for effective treatment strategies.

Purpose of the Study:

• To delineate the distinct etiopathogenetical features of "high" gastric ulcers versus "low" (pyloroantral) gastric ulcers.
• To compare these characteristics with those of healthy individuals.

Main Methods:

• A study involving 96 patients with relapsing GUD, categorized into "high" (n=58) and pyloroantral (n=38) ulcer groups.
• All patients underwent esophagogastroduodenoscopy and 24-hour intragastric pH-metry before antisecretory therapy.
• Data were compared with 100 healthy control subjects.

Main Results:

• "High" ulcers exhibited normal intragastric acidity and circadian dynamics, but significantly prolonged duodenogastral reflux (DGR).
• "Low" ulcers were characterized by high acidity in the corpus and antrum, absent normal daily pH variations, increased nocturnal acidity, and reduced DGR frequency and duration.
• Intragastric acidity in "high" ulcer patients was comparable to healthy individuals.

Conclusions:

• "High" gastric ulcers are associated with normal acid production and increased, sustained duodenogastral reflux.
• "Low" (pyloroantral) ulcers present a combination of high hyperacidity and significantly reduced duodenogastral reflux.