Abstract
Heterogeneity is the most important consideration in the pathophysiology of peptic ulcer disease. Acute ulcers and erosions present clinically with gastrointestinal bleeding or perforation. if they heal there is no predictable recurrence. Factors concerned with mucosal defense are relatively more important than aggressive factors such as acid and pepsin. Local ischemia is the earliest recognizable gross lesion. The gastric mucosa is at least as vulnerable as the duodenal mucosa and probably more so. Most drug-induced ulcers occur in the stomach. Chronic or recurrent true peptic ulcers (penetrating the muscularis mucosae) usually present with abdominal pain. Many duodenal ulcer patients report that the pain occurs when the stomach is empty or is relieved by food, and follows a pattern of relatively long periods of freedom from symptoms between recurrences. Approximately 50% of patients experience a recurrence within a year if anti-ulcer medication is stopped. In most western countries recurrent duodenal ulcer is more common than gastric ulcer. Peptic ulcer disease is also more common in men. Recent evidence indicates genetic and familial factors in duodenal ulcer and increased acidpepsin secretion in response to a variety of stimuli. However, it is also becoming clear that of all the abnormal functions noted, few are present in all subjects and many are clustered in subgroups. In chronic gastric ulcer of the corpus, defective defense mechanisms, such as duodenogastric reflux and atrophic gastritis, seem to be more important than aggressive factors. Nevertheless, antisecretory medications accelerate the healing of such ulcers. It remains to be seen whether prostaglandins, mucus secretion, or gastric mucosal blood flow are impaired in chronic ulcer disease.
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References
Brooks FP: The pathophysiology of peptic ulcer: An overview.In Peptic Ulcer, New York, Churchill Livingstone, in press, pp 51–60
Sava G: Ulcérations et ulcère aigus de l'estomac. France Medicale 30:274, 1967
Hunt PS, Korman MG, Hansky J, Schmidt GT, Hillman HS: Acute gastric ulceration: A prospective study of incidence and results of management. Aust NZ J Med 10(3):305–308, 1980
Davenport HW: Salicylate damage to the gastric mucosal barrier. N Engl J Med 276:1307–1312, 1967
Davenport HW: Gastric mucosal injury by fatty acid and acetylsalicylic acids. Gastroenterology 46:245–253, 1965
Munro DR: Route of protein loss during a model proteinlosing gastropathy in dogs. Gastroenterology 66:960–972, 1974
Davenport HW, Kauffman GL Jr: Plasma shedding by the canine. Oxyntic and pyloric glandular mucosa induced by topical action of acetylcholine. Effect of atropine and physostymine. Gastroenterology 69:190–197, 1975
Wood JG, Davenport HW: Measurement of canine vascular permeability to plasma proteins in the normal and protein-losing states. Gastroenterology 82:725–733, 1982
Geall MG, Phillips SF, Summerskill WHJ: Profile of gastric potential difference in man: Effects of aspirin, alcohol, bile and endogenous acid. Gastroenterology 58:437–443, 1970
Murray HS, Strottman MP, Cooke AR: Effect of several drugs on gastric potential difference in man. Br Med J 1:19–21, 1974
Morris GP, Wallace JL, Harding PL, Krausse EJ, Lolle SJ: Correlations between changes in indicators of gastric mucosal barrier integrity at time of exposure to “Barrier Breakers” and extent of hemorrhagic erosions one hour later. Dig Dis Sci 29:6–11, 1984
Silen W, Schiessel R, Kivilaakso E: The gastric mucosal barrier and ulceration. Brain Res Bull 5(Suppl 1):3–6, 1980
Kivilaakso E, Bargilai A, Schiessel R, Fromm D, Silen W: Experimental ulceration of rabbit antral mucosa. Gastroenterology 80:77–83, 1981
O'Brien P, Silen W: Influence of acid secretory state on the gastric mucosal tolerance to back diffusion of H+. Gastroenterology 71:760–765, 1976
Kivilaakso E: High plasma HCO3 protects gastric mucosa against acute ulceration in the rat. Gastroenterology 81:921–927, 1981
O'Brien P, Bushnell M: Role of acid-base status in the responses of the isolated amphibian gastric mucosas to back diffusion of H+. Gastroenterology 79:439–445, 1980
Menguy R: Role of gastric mucosal energy metabolism in the etiology of stress ulceration. World J Surg 5:175–179, 1981
Silen W: The prevention and management of stress ulcers. Hosp Pract, March 1980, 15:pp 93–100
Czaja AJ, McAlhany JC, Pruitt BA Jr: Acute gastroduodenal disease after thermal injury: An endoscopic evaluation. N Engl J Med 291:925–928, 1974
Kamada T, Sato N, Kawano S, Fusamoto H, Abe H: Gastric mucosal dynamics after thermal or head injury: A clinical application of reflectance spectrophotometry. Gastroenterology 83:535–540, 1982
Mersereau WA, Hinchey EJ: Effect of gastric acidity on gastric ulceration induced by hemorrhage in the rat utilizing a gastric chamber technique. Gastroenterology 64:1130–1135, 1973
Garner A, Flemström G, Allen A, Heylings JR, McQueen S: Gastric mucosal protective mechanisms: Roles of epithelial bicarbonate and mucus secretions. Scand J Gastroenterol 19(Suppl 101):79–86, 1984
Kauffman GL Jr, Ligumsky M: Role of endogenous prostaglandins in gastric mucosal integrity.In Mechanisms of Mucosal Protection in the Upper Gastrointestinal Tract, A Allen, G Flemström, A Garner, W Silen, LA Turnberg (eds). New York, Raven Press, 1984, pp 317–322
Hollander F: The two-component mucus barrier. Arch Intern Med 94:107–120, 1974
Hurst BC, Rees WDW, Garner A: Cell shedding by the stomach and duodenum.In Mechanisms of Mucosal Protection in the Upper Gastrointestinal Tract, A Allen, G Flemström, A Garner, W Silen, LA Turnberg (eds). New York, Raven Press, 1984, pp 21–26
Chaudhury TK, Robert A: Prevention by mild irritants of gastric necrosis produced in rats by sodium taurocholate. Dig Dis Sci 25:830–836, 1980
Robert A: Role of endogenous and exogenous prostaglandins in mucosal protection.In Mechanisms of Mucosal Protection in the Upper Gastrointestinal Tract, A Allen, G Flemström, A Garner, W Silen, LA Turnberg (eds). New York, Raven Press, 1984, pp 377–382
Ito S, Lacy ER, Rutten MJ, Critchlow J, Silen W: Rapid repair of injured gastric mucosa. Scand J Gastroenterol 19(Suppl 101):87–95, 1984
Robert A: Cytoprotection: What it is and what it is not.In Mechanisms of Mucosal Protection in the Upper Gastrointestinal Tract, A Allen, G Flemström, A Garner, W Silen, LA Turnberg (eds). New York, Raven Press, 1984, pp 381–382
Svanes K, Critchlow J, Takeuchi K, Magee D, Ito S, Silen W: Factors influencing reconstitution of frog gastric mucosa: Role of prostaglandins.In Mechanisms of Mucosal Protection in the Upper Gastrointestinal Tract, A Allen, G Flemström, A Garner, W Silen, LA Turnberg, (eds). New York, Raven Press, 1984, pp 33–39
Lacy ER, Ito S: Ethanol-induced insult to the superficial rat gastric epithelium: A study of damage and rapid repair.In Mechanisms of Mucosal Protection in the Upper Gastrointestinal Tract, A Allen, G Flemström, A Garner, W Silen, LA Turnberg (eds). New York, Raven Press, 1984, pp 49–63
Ito S, Lacy ER: Characteristics of ethanol-induced lesions in rat gastric mucosa.In Mechanisms of Mucosal Protection in the Upper Gastrointestinal Tract, A Allen, G Flemström, A Garner, W Silen, LA Turnberg (eds). New York, Raven Press, 1984, pp 57–63
Pruitt BA, Foley FD, Moncrief JA: Curling's ulcer: A clinical pathology study of 323 cases. Ann Surg 172: 523–539, 1970
Zach GA, Gyr KE, Alvenslebew E, Mills JG, Stalder GA, Dunn SL, Bloom SA: Double-blind, randomized, controlled study to investigate the efficacy of cimetidine given in addition to conventional therapy in the prevention of stress ulceration and hemorrhage in patients with acute spinal injury. Digestion 29:214–222, 1984
Ivey KJ: Drugs, gastritis, and peptic ulcer. J Clin Gastroenterol 3 (Suppl 2):29–34, 1981
Domschke S, Domschke W: Gastroduodenal damage due to drugs, alcohol and smoking. Clin Gastroenterol 13:405–436, 1984
Rees WDW, Gibbons LC, Warhurst G, Turnberg LA: Studies of bicarbonate secretion by the normal human stomach in vivo: Effect of aspirin, sodium taurocholate, and prostaglandin E2.In Mechanisms of Mucosal Protection in the Upper Gastrointestinal Tract, A Allen, G Flemström, A Garner, W Silen, LA Turnberg (eds). New York, Raven Press, 1984, pp 119–123
Silvoso GR, Ivey KJ, Butt JH, Lockard OD, Holt SD, Sisk C, Baskin WN, Mackercher PA, Hewett J: Incidence of gastric lesions in patients with rheumatic disease on chronic aspirin therapy. Ann Intern Med 91:517–520, 1979
Carlson D, Gerber E, Weinstein W, Grossman MI, Bluestone R, Guth P: Drug-associated gastroduodenal lesions in rheumatoid arthritis: An endoscopic and histologic study. Gastroenterology 78:1147, 1980
Welch RW, Bantch HL, Harris SC: Reduction of aspirin-induced gastrointestinal bleeding with cimetidine. Gastroenterology 74:459–463, 1978
Muller P, Dammann HG, Simon B, Kommerell B: Prostaglandins and human gastric mucosa: Molecular aspects and protective properties.In Mechanisms of Mucosal Protection in the Upper Gastrointestinal Tract, A Allen, G Flemström, A Garner, W Silen, LA Turnberg (eds). New York, Raven Press, 1984, pp 311–316
Stern AI, Hogan DL, Sandersfield MA, Kahn LH, Isenberg JI: Do low doses of 15(R) 15 Methyl-PGE2 (MPGE) prevent aspirin (ASH) induced gastric damage in man? Gastroenterology 84:1325, 1983
Gilbert DA, Surawicz CM, Silverstein FE, Weinberg CR, Saunders DR, Feld AD, Sanford RL, Bergman D, Washington P: Prevention of acute aspirin-induced gastric mucosal injury by 15R-15R methyl prostaglandin E2: An endoscopic study. Gastroenterology 86:339–345, 1984
Hunt JN, Smith JL, Jiang CL, Kessler L: Effect of synthetic prostaglandin E1 analog on aspirin-induced bleeding and secretion. Dig Dis Sci 28:897–902, 1983
Konturek SJ, Kwiecien N, Obtulowicz W, Polanski M, Kopp B, Oleksy J: Comparison of prostaglandin E2 and ranitidine in prevention of gastric bleeding by aspirin in man. Gut 24:89–93, 1983
Graham DY, Smith JL, Dobbs SM: Gastric adaptation occurs with aspirin administration in man. Dig Dis Sci 28:1–6, 1983
Tesler MA, Lim ES: Protection of gastric mucosa by sucralfate from aspirin-induced erosions. J Clin Gastroenterol 3(Suppl 2):175–179, 1981
Palmer ED: Gastritis: A Revaluation. Medicine 33: 199–280, 1954
Brosinne A: Effects of ethanol on plasma protein shedding in the human stomach. Dig Dis Sci 24:44–47, 1979
Ivey KJ, Den Besten L, Clifton JA: Effect of bile salts on ionic movement across the human gastric mucosa. Gastroenterology 59:683–690, 1970
Duane WC, Wiegand DM, Gilberstadt ML: Intragastric duodenal lipids in the absence of a pyloric sphincter: Quantitation, physical state, and injurious potential in the fasting and post prandial states. Gastroenterology 78: 1480–1487, 1980
Fimmel CJ, Müller-Lissner SA, Blum AL: Acute bile salt-induced mucosal damage in man: Time course and effect of misoprostol a PGE1-analogue.In Mechanisms of Mucosal Protection in the Upper Gastrointestinal Tract, A Allen, G Flemström, A Garner, W Silen, LA Turnberg (eds). New York, Raven Press, 1984, pp 341–349
Skillman JJ, Bushell LS, Goldman H, Silen W: Respiratory failure, hypotension, sepsis, and jaundice: A clinical syndrome with lethal hemorrhage from acute stress ulceration of the stomach. Am J Surg 117:523–530, 1969
Skillman JJ, Gould SA, Chung RSK, Silen W: The gastric mucosal barrier: Clinical and experimental studies in critically ill and normal man and in the rabbit. Ann Surg 172:564–584, 1970
Fiddian-Green RJ, McGough E, Pittenger G, Rothman E: Prediction value of intramural pH and other risk factors for massive bleeding from stress ulceration. Gastroenterology 85:613–620, 1983
Lucas CE, Sugawa C, Friend W, Walt AS: Therapeutic implications of disturbed gastric physiology in patients with stress ulceration. Am J Surg 123:25–34, 1972
Weiss JB, Peskin GW, Isenberg JI: Treatment of hemorrhagic gastritis with 15(R)-15 methyl prostaglandin E2: Report of a case. Gastroenterology 82:558–560, 1982
Smith FH, Jordan SM: Gastric ulcer: A study of 600 cases. Gastroenterology 11:575–597, 1948
Flood CA, Hennig GC: Recurrence in gastric ulcer under medical management. Gastroenterology 16:57–72, 1950
Smith FH, Boles RS Jr, Jordan SM: Problems of the gastric ulcer reviewed—Study of one thousand cases. JAMA 153:1505–1508, 1953
The Veterans Administration co-operative study on gastric ulcer. Gastroenterology 61:561–564, 1971
Halse SA, Kristensen E, Moller-Jensen O, Morkbak NK: Prognosis of medically treated gastric ulcer. Scand J Gastroenterol 12:489–495, 1977
Piper DW, Shinners J, Greig M, Thomas J, Waller SL: Effect of ulcer healing on the prognosis of chronic gastric ulcer. Gut 19:419–424, 1978
Miyake T, Ariyoshi J, Suzaki T, Oishi M, Sakai M, Ueda S: Endoscopic evaluation of the effect of sucralfate therapy and other clinical parameters on the recurrence rate of gastric ulcers. Dig Dis Sci 25:1–7, 1980
Wright JP, Kahavovitz C, Marks IN: Gastric ulceration: A follow-up study. S Afr Med J 60 (16):611–612, 1981
Gertler S, Isenberg J, Elashoff J, Reedy T, Sandersfield M, Peterson W: Gastric ulcer recurrence following medical healing. Gastroenterology 84:1164, 1983
Jensen KB, Mollman K-M, Rabbek I, Madsen JR, Rune SJ, Wolff HR: Prophylactic effect of cimetidine in gastric ulcer patients. Scand J Gastroenterol 14:175–176, 1979
Alstead EM, Ryan FP, Holdsworth CD, Ashton MG, Moore M: Ranitidine in the prevention of gastric and duodenal ulcer relapse. Gut 24:418–420, 1983
Barr GD, Kang JY, Canalese J, Piper DW: A two-year prospective controlled study of maintenance cimetidine and gastric ulcer. Gastroenterology 85:100–104, 1983
Hentschel E, Schultze K, Weiss W, Rudiger E, Judmaci G, Reichel W, Kerstan E, Horton J: Effect of cimetidine treatment in the prevention of gastric ulcer relapse: A one year double blind multicentre study. Gut 24:853–856, 1983
Mowat NAG, Needham CD, Brunt PW: The natural history of gastric ulcer in a community: A four-year study. Quart J Med 44:45–56, 1975
Johnson HD: The classification and principles of treatment of gastric ulcers. Lancet 2:518–520, 1957
Oi M, Oshida K, Sugimura S: The location of gastric ulcer. Gastroenterology 36:45–56, 1959
Kirkpatrick JR, Lawrence JH, Forrest APM, Campbell H: The short pentagastrin test in the investigation of disease. Gut 10:760–762, 1969
Chapman MA, Werther JL, Janowitz HD: Response of the normal and pathological human gastric mucosa to an instilled acid load. Gastroenterology 55:344–353, 1968
Ornsholt J, Amdrup E, Andersen D, Hostrup H: Arhus county (Denmark) vagotomy trial: Acid secretory patterns in patients with prepyloric, pyloric and duodenal ulcer. Digestion 26(3):146–152, 1983
Schlegel W, Wenk K, Dollinger HC, Raptis S: Concentrations of prostaglandin A-, E- and F-like substances in gastric mucosa of normal subjects and of patients with various gastric diseases. Clin Sci Mol Med 52:255–258, 1977
Wright JP, Young GO, Klaff LJ, Weers LA, Price SK, Marks IN: Gastric mucosal prostaglandin E levels in patients with gastric ulcer disease and carcinoma. Gastroenterology 82:263–267, 1982
Kobayashi K, Arakawa T, Nakamura H, Yamamoto S: An endoscopic study on the mucosal prostaglandin level in patients with peptic ulcer. World Congress of Gastroenterology, Stockholm, 1982, Abstr. 108
Garrett JM, Summerskill WHJ, Code CF: Antral motility in patients with gastric ulcer. Am J Dig Dis 11:780–789, 1966
Miller LS, Malagelada JR, Longstreth GF, Go VLW: Dysfunction of the stomach with gastric ulceration. Dig Dis Sci 25:857–864, 1980
Fisher RS, Cohen S: Pyloric-sphincter dysfunction in patients with gastric ulcer. N Engl J Med 288:274–276, 1973
Müller-Lissner SA, Fimmel CJ, Sonnenberg A, Will N, Midler-Duysing W-M, Heinzel F, Muller R, Blum AL: Novel approaches to quantify duodenogastric reflux in healthy volunteers with type I gastric ulcer. Gut 24:510–518, 1983
Janowitz HD: Bile in the stomach: Gastroenterology 57:356–357, 1969, Editorial comment
Alexander-Williams J, Wolverson RL: Pathogenesis and pathophysiology of gastric ulcer. Clin Gastroenterol 13:601–619, 1984
Fukutomi H, Yamagata J, Takase Y, Takao S: Endoscopical measurement of gastric blood flow of the patients with gastric ulcer. World Congress of Gastroenterology, Stockholm, 1982, Abstr. 777
Kamada T, Kawano S, Sato N, Fukuda M, Fusamoto H, Abe H: Gastric mucosal blood distribution and its changes in the healing process of gastric ulcer. Gastroenterology 84:1541–1546, 1983
Thomas J, Greig M, Piper DW: Chronic gastric ulcer and life events. Gastroenterology 78:905–911, 1980
Peters MN, Richardson CT: Stressful life events, acid hypersecretion and ulcer disease. Gastroenterology 84:114–119, 1983
Isenberg JI, Peterson WL, Elashoff JD, Sandersfield MA, Reedy TJ, Ippoliti AF, Van Deventer GM, Franki H, Longstreth FG, Anderson DS: Healing of benign gastric ulcr with low-dose antacid or cimetidine: A double-blind, randomized, placebo-controlled trial. N Engl J Med 308:1319–1323, 1983
Kellow JE, Barr GD, Cowen AE, Ward M, Wood L, Piper DW: Comparison of ranitidine and cimetidine in the treatment of chronic gastric ulcer. Digestion 27:105–110, 1983
Barbara L, Corinaldesi R, Dobrilla G, Defretis G, Bianchi Porro G, Parada A, Currata R, Paoluzi P, Mazzacca G, Sabbatini F, Scuro LA, Civallini G, Verne G, Pera A: Ranitidine vs cimetidine short term treatment of gastric ulcer. Hepato-gastroenterology 30:151–153, 1983
La Brooy S, Taylor R, Hunt R, Golding T, Laidlaw J, Chapman R, Founder R, Vincent S, Colin-Jones D, Milton-Thompson G, Misiewicz J: Controlled comparison of cimetidine and carbenoxolone sodium in gastric ulcer. Br Med J 1:1308–1309, 1979
Sutton DR: Gastric ulcer healing with tripotassium dicitrito bismuthate and subsequent relapse. Gut 23:621–624, 1982
Morgan AG, McAdam WAF, Pacsoo C, Darnborough A: Comparison between cimetidine and caved-S in the treatment of gastric ulceration and subsequent maintenance therapy. Gut 23:545–551, 1982
Nagashima R: Mechanisms of action of sucralfate. J Clin Gastroenterol 3 (Suppl 2):117–127, 1981
Tytgat GNJ, Hameeteman W, Olffen GH: Sucralfate, bismuth compounds, substituted-benzimidazoles, trimipramine and pirenzepine in the short- and long-term treatment of duodenal ulcer. Clin Gastroenterol 13:543–568, 1984
Rybicka J, Gibinski K: Methyl-prostaglandin E2 analogs for healing of gastro-duodenal ulcers. Scand J Gastroenterol 13:155–160, 1978
Valnes K, Myren J, Ovigstad T: Trimipramine in the treatment of gastric ulcer. Scand J Gastroenterol 13: 497–500, 1978
Black RB, Rhodes J, Davies GT, Gravelle H, Sweetnam P: A controlled clinical trial of cholestyramine in the treatment of gastric ulcer. Gastroenterology 61:821–825, 1971
Kelly KA, Malagelada J-R: Medical and surgical treatment of chronic gastric ulcer. Clin Gastroenterol 13:621–634, 1984
Doll R, Pygott F: Factors influencing the rate of healing of gastric ulcer: Admission to hospital, phenobarbitone and ascorbic acid. Lancet 1:171–175, 1952
Piper DW, Hunt J, heap TR: The healing rate of chronic gastric ulcer in patients admitted to hospital. Scand J Gastroenterol 15:113–117, 1980
Herrmann RP, Piper DW: Factors influencing the healing rate of chronic gastric ulcer. Am J Dig Dis 18:1–6, 1973
James O, Kenefick JS: Pain in gastric ulcer. Lancet 1:562, 1974
Feldman M: Neural and hormonal factors in peptic ulcer disease. J Clin Gastroenterol 3 (Suppl 2):51–56, 1981
Feldman M, Richardson CT, Fordtran JS: Sham feeding in DU patients. Letter to editor. Gastroenterology 79:1353–1354, 1980
Lam SK, Lai CL, Lee NW, Fok KH, Ng M, Siv KF, Wong J: Effective healing of duodenal ulcer with single night time dose of oxmetidine: A double-blind controlled study. Gastroenterology 85:1221, 1983
Gledhill T, Howard OM, Buck M, Paul A, Hunt RH: Single nocturnal dose of an H2 receptor antagonist for the treatment of duodenal ulcer. Gut 24:904–908, 1983
McCloy RF, Greenberg GR, Baron JH: Duodenal pH in health and duodenal ulcer disease. Gut 25:386–392, 1984
Malagelada J-R, Longstreth GF, Deering TB, Summerskill WHJ, Go VLW: Gastric secretion and emptying after ordinary meals in duodenal ulcer. Gastroenterology 73:992, 1977
Morrissey SM, Ward PM, Jayaraj AP, Tobey FI, Clark CG: Histochemical changes in mucus in duodenal ulceration. Gut 24:909–913, 1983
Olsen PS, Pedersen JH, Kirkegaard P, Been H, Stadil F, Fahrenkrug J, Christiansen J: Neurotensin induced inhibition of gastric acid secretion in duodenal ulcer patients before and after parietal cell vagotomy. Gut 25:481–484, 1984
Coluti TJ, Unger RH, Feldman M: Role of circulating somatostatin in regulation of gastric acid secretion, gastric release, and islet cell function. Studies in healthy subjects and duodenal ulcer patients. J Clin Invest 74:417–423, 1984
Christiansen J, Kirkegaard P, Olsen PS, Petersen B: Interaction of calcium and gastrin on gastric acid secretion in duodenal ulcer patients. Gut 25:174–177, 1984
Lorenz W, Troidl H, Barth H, Rohoe H, Schulz S, Becker H, Dormann P, Schmal A, Kusche J, Meyer R: Stimulusecretion coupling in the human and canine stomach: Role of histamine.In Stimulus Secretion Coupling in the Gastrointestinal Tract, RM Case, H Goebell (eds). Lancaster, England, MTP Press, 1975, p 177
Dubey P, Kundy S: Simultaneous measurement of gastric and duodenal alkali secretion by in situ titration in health and disease. Gut 24:1126–1129, 1983
Rachmilewitz D, Branski D, Sharon P, Karmeli F: The possible role of endogenous prostanoids in the pathogenesis of peptic ulcer.In Mechanisms of Mucosal Protection in the Upper Gastrointestinal Tract, A Allen, G Flemström, A Garner, W Silen, LA Turnberg (eds) New York, Raven Press, 1984, pp 329–333
Guth PH, Baumann H, Grossman MI, Aures D, Elashoff J: Measurement of gastric mucosal blood flow in man. Gastroenterology 74:831–834, 1978
Lam SK: Pathogenesis and pathophysiology of duodenal ulcer. Clin Gastroenterol 18:447–472, 1984
Thomas JM, Misiewicz G: Histamine H2 receptor antagonists in the short and long-term treatment of duodenal ulcer. Clin Gastroenterol 13:501–541, 1984
Hamilton I, Worsley BW, O'Connor HJ, Axon TR: Effects of tripotassium dicitrato bismuthate (TDB) tablets or cimetidine in the treatment of duodenal ulcer. Gut 24:1148–1151, 1983
Walan A, Bergsaker-Aspoy J, Farup P, Gillberg R, Halvorsen L, Kilander A, Lind T, Noesdal J, Offergaard S: Four week study of the rate of duodenal ulcer healing with omeprazole. Gut 24:A792, 1983
Howden CW, Forrest JAH, Reid JL: Effects of single and repeated doses of omeprazole on gastric acid and pepsin secretion in man. Gut 25:707–710, 1984
Sachs G: Pump blockers and ulcer disease. N Engl J Med 310:785–786, 1984
Pounder RE: Duodenal ulcers that will not heal. Gut 25:697–702, 1984
Lam SK, Lee NW, Koo J, Hui WM, Fox KH, Ng M: Randomized crossover trial of tripotassium dicitrato bismuthate versus high dose cimetidine for duodenal ulcers resistant to standard dose of cimetidine. Gut 25:703–706, 1984
Bardhan KD: Refractory duodenal ulcer. Gut 25:711–715, 1984
Malinowska DH, Sachs G: Cellular mechanisms of acid secretion. Clin Gastroenterol 13:322, 1984
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Brooks, F.P. The pathophysiology of peptic ulcer disease. Digest Dis Sci 30 (Suppl 11), 15S–29S (1985). https://doi.org/10.1007/BF01309381
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DOI: https://doi.org/10.1007/BF01309381