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technique. Nevertheless, the afore-mentioned acridine orange method can provide

b e t t e r informations on the process.

(5) DIFFERENCE BETWEEN GASTRIC ULCER A N D

DUODENAL ULCER
H a r u y a Okabe, M.D.
2nd Department of Internal Medicine, Kyushu Univ. (Director Prof. S. Katsuki)

Introduction It has been well known t h a t there are m a n y differences between

g a s t r i c and duodenal ulcers; i.e. the earlier average age period of the patients
with duodenal ulcers, the greater incidence of duodenal ulcer in the male with
the more even distribution in the two sexes of gastric ulcer, the v e r y clear
differences in the pattern of gasric secretion produced by these two different ulcers
and so on.
Because of these differences, there have deen two opposing opinions concerning
wheter these two ulcers are essentially same or different. S h a y and Sun believe
t h a t the changes of gastric motility and gastric secretion actually represent effects
produced by the two lesions in their respective areas r a t h e r than differences in the
fundamental mechanisms responsible for their production.
On the other hand, Dragstedt developed his opinion t h a t duodenal ulcers are
usually due to hypersecretion of gastric juice of nervous origin and t h a t gastric
ulcers are usually due to a hypersecretion of gastric juice of humoral origin.
McConnell emphasized that the gastric and duodenal ulcer m u s t be considered
seperately because fo convincing evidence that they are inherited independently.
It has to be said t h a t the question whether gastric ulcer and duodenal ulcer
are essentially the same disease located in different anatomic areas or whether
they are different diseases has not been settled.
We have re-examined deliberately X-ray films of the upper G. I-tract and
g a s t r o c a m e r a films of the consecutive 10,000 ambulant patients who visited a
Diagnostic Center of Stomach Diseases during more than 4 years f r o m Dec. 1964
to Feb. 1969.
Materials and methods: Eleven hundred ninety-two cases with gastric ulcer
alone, 659 cases with duodenal ulcer alone, and 236 cases with combined ulcers
were extracted f r o m the 10,000 paients. The all patients were divided into 7 age-
groups ranging from second to 8th decades. Comparison of the frequencies of the
gastric, duodenal and combined ulcers on each decades were performed. Gastric
secretory p a t t e r n s and blood types were compared with each other among these
3 groups with different ulcers.
Results 1. Among the 7 age-groups consisting of the 10,000 consecutive
patients, the group of the 4th age-decade is the numerous. T h e more far the age-
group f r o m this peak decade, the less in numbers of the patients in both sides.
2. The n u m b e r of the patients with gastric ulcer are the most numerous in
the 6th decade, t h a t with duodenal ulcer in the 4th, and t h a t with combined
ulcer in 5th.
3. The p a t t e r n s of the frequencies in percent of gastric, duodenal and combined
ulcers in each decades f r o m the second to the 8th are quite characteristic in these
3 groups. T h e frequency of the gastric ulcer increases steady following age
advances until the peak in 7th decade, while that of the duodenal ulcer decreases
f r o m the peak in 3rd decade steady. T h a t of combined ulcer also increases in
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order of age more rapidly than t h a t of gastric ulcer until 5th decade in peak.
4. The p a t t e r n of frequencies of the all duodenal ulcer including the combined
ulcers in each decades reveals t h a t the highest frequency covers over 3 decades
ranging f r o m 3rd to 5th in quite same percent, and then decreases slowly in order
of age.
From the results above described, the following hypothesis are thinkable: 1) T h e
new occurence of duodenal ulcer m a y finish by 5th decade and be quite few or
not after t h a t age.
2) The r a t e of the duodenal ulcer combined with gastric ulcer to the all duodenal
ulcer increases as the age advances, then the rate of the duodenal ulcer alone
decreases. 3) In the combined ulcer, therefore, the duodenal ulcer usually antedates
to the gastric ulcer.
To prove these hypothesis, we need to m a k e more detailed s t u d y in further.
5. The observed rates of the combined ulcer in each decades are significantly
higher than the expected rates in most decades. This means t h a t a certain factor
yet unknown accelerates the occurence of combined ulcer. If the hypothesis above
mentioned is right, the antedated duodenal ulcer might be this accelerating factor.
6. The results of the gastric secretory p a t t e r n following histamine meal are
quite different between gastric and duodenal ulcer groups. T h a t of combined
ulcer is in-between but nearer to t h a t of the duodenal ulcer.
7. In comparison of the blood t y p e s a m o n g these 3 groups, type 0 is much in
duodenal ulcer group than in gastric ulcer group, which is significant.
Conclusion F r o m the results above described, I feel inclined to separate the
gastric ulcer f r o m the duodenal ulcer as different entity. Also, I think that the
gastric ulcer combined to the duodenal ulcer will be not quite same with the
gastric ulcer alone in their etiology, if any at all.

(6) SPECIAL COMMENT TO " COMPARISON B E T W E E N

GASTRIC AND DUODENAL U L C E R S "
T. Sakai, M.D.
Department of Surgery, University of Niigata, School of Medicine, Niigata
There m i g h t be several points of view concerning the comparison between the
gastric and duodenal ulcer groups, such as differences in pathogenesis or clinical
manifestations since the ulcers have once been established as an illness. M y
particular emphasis at the present discussion will be however concentrated in the
following factors, namely, 1) blood type, 2) urinary uropepsin level, 3) dynamic
h u m a n constitution, and 4) mode of gastric acid secretion.
As to the blood type, the results were obtained on the basis of x 2 method on
the difference between the actual figures of the patients with gastric and duodenal
ulcers and expectant figures calculated f r o m the control distribution of the blood
types in the district of Niigata prefacture. The result of this s t u d y indicates t h a t
the gastric ulcers frequently occur in the patients with O and B types, and t h e
duodenal ulcers in those with O and AB types. The ulcers of either group are
however less frequently encountered in the patients with A type.
The urinary uropepsin levels in both gastric and duodenal ulcer groups are well
over the average level of the control group, and the particular emphasis should
be made t h a t those in the latter group are in all cases present far in excess o f
the upper limit of the normal value.