Prepyloric gastric ulceration.

The evidence in this contribution is based on the examination of 15 human antrectomy specimens removed for PPU , together with the evidence obtained from a comparison of the amount, degree, and distribution of chronic gastritis in an example of a typical DU, GU, and PPU . The evidence indicates that there is chronic gastritis in all PPUs , which is much less than that seen in GU, but is considerably greater than that seen in the stomach of a patient with a DU. In PPU the level of acid secretion may vary, and as a hypothesis it is suggested that PPU should be regarded as a mixed type of disease, in which both chronic gastritis and the effects of acid secretion are important. In individual instances either one or both of these components may be of particular importance, and in this way PPU is different from the more usual type of duodenal or gastric ulcer. For surgical management to be successful in PPU , both components should be treated. In PPU it appears that the higher the acid output, the nearer toward the duodenum the ulcer is likely to occur, with perhaps the greater curve ulcers showing a higher level of acid secretion than ulcers occurring on the lesser curvature. Whether or not the hypothesis is correct remains to be established, but it does have the single advantage that it explains most of the problems known to be associated with PPU , and perhaps even more important, it suggests a rational form of surgical management. When more information is available it may be possible to define which of the different factors are important in each instance and therefore to offer individual patients the surgical procedure appropriate to their specific needs.