A histological assessment of prepyloric ulceration and a hypothesis relating to acid secretion

Fifteen human antrectomy specimens removed for prepyloric ulceration have been examined using the 'Swiss roll' technique. A limited amount of severe chronic gastritis has been shown to be present on the lesser or greater curvature in 9 cases, depending on the position of the ulcer. Gastritis persisted in spite of histological healing of the ulcer in a further 6 cases. This is presented as evidence to support the view that limited severe gastritis may be of importance in the pathogenesis of prepyloric ulceration. An hypothesis is advanced suggesting that acid hypersecretion leading to ulceration within the area of gastritis may be an additional second factor of importance in some cases, and that the distance of the ulcer from the duodenum would depend on the level of acid hypersecretion.