Neeman A, Marks I N
S Afr Med J. 1984 Jun 23;65(25):1012-4.
In 41 patients in whom endoscopy showed benign gastric ulcer, gastric secretory function was assessed before and after stimulation with pentagastrin (6 micrograms/kg); they were then followed up for a period of 2-4 years. Of these 41 patients, 37 had benign and the remaining 4 malignant ulcers. Of the 37 patients with benign gastric ulcers, 11 had basal achlorhydria but all secreted acid after pentagastrin stimulation. Seven of these 37 patients (19%) secreted less than 5 mmol/h in response to stimulation with pentagastrin. Of the 4 patients with malignant gastric ulcer, 3 had basal achlorhydria. After pentagastrin stimulation 3 of these patients (75%) secreted up to 5 mmol/h and 1 patient secreted 17 mmol/h. Biopsy evidence of malignancy was only obtained after repeat endoscopy and biopsy in 2 of these 4 patients. The present study confirms that a malignant ulcer may simulate a benign ulcer on endoscopy, and shows that the finding of hypochlorhydria in such patients warrants a cautious approach with repeat endoscopy and biopsy to exclude a malignant lesion.
对41例经内镜检查显示为良性胃溃疡的患者，在给予五肽胃泌素（6微克/千克）刺激前后评估其胃分泌功能；然后对他们进行了2至4年的随访。在这41例患者中，37例为良性溃疡，其余4例为恶性溃疡。在37例良性胃溃疡患者中，11例基础胃酸缺乏，但所有患者在五肽胃泌素刺激后均分泌胃酸。这37例患者中有7例（19%）在五肽胃泌素刺激下分泌量少于5毫摩尔/小时。在4例恶性胃溃疡患者中，3例基础胃酸缺乏。五肽胃泌素刺激后，这些患者中有3例（75%）分泌量高达5毫摩尔/小时，1例患者分泌量为17毫摩尔/小时。这4例患者中有2例仅在重复内镜检查和活检后才获得恶性肿瘤的活检证据。本研究证实，恶性溃疡在内镜检查中可能类似良性溃疡，并表明在此类患者中发现胃酸缺乏需要谨慎对待，应重复内镜检查和活检以排除恶性病变。
