CLINICAL AND ENDOSCOPIC STUDY OF GASTRIC EROSIONS

Abstract

This is a clinical and endoscopic study of gastric erosions. The varioliform erosion is occasionally classified into "disappearing" type (gastritis erosiva) and "continuous" type (gastritis verrucosa). However, it is difficult to distinguish these two types by only one endoscopic examination, and final dicision needs repeated observations for a long term. In this paper, it is proposed to classify gastric erosions into "varioliform", "punctiform in addition to the former classification and mixed" type. "Punctiform" is subdivided into "flecked" and "dotted" type. 1. Under repeated endoscopic observations, gastritis erosiva usually changed from varioliform to flecked type and further to dotted type, while gastritis verrucosa did not show any morphological change. 2. The subjective symptoms in varioliform were more manitest than those in punctiform. The onset of symptoms was most frequent in March, April and November. Gastric erosions were found most often among the fourth decades, and over 50% located in the antrum. 3. Gastric erosions and duodenal ulcer were frequently found together. 38.6% of all patients with duodenal ulcer also had gastric erosions. The duodenal ulcer was found in 54.1% of all patients with gastric erosions. As the duodenal ulcer improved, some of the coexistent gastric erosions also changed from varioliform to punctiform. On the other hand, in case that the duodenal ulcer deteriorated, the erosions changed to varioliform again. 4. A decrease of maximal acid output (MAO) was observed according to the change from varioliform to punctiform. This was not seen in the cases of duodenal ulcer without gastric erosions. This may suggest the close relationship between gastritis erosiva and the acidity of the gastric juice. 5. It was difficult to distinguish gastritis erosiva from gastritis verrucosa by biopsy. Also histological findings of gastritis erosiva was not characteristic of any stage, for an inflammatory cellular infiltration was the only and common finding. It is suggested that the appearance of gastric erosions is greatly related to the damage of the mucosal barrier as well as the acidity of the gastric juice.