Identification of two subgroups of familial early-onset duodenal ulcers.

Pentagastrin-stimulated maximal acid output and postprandial integrated gastrin response (sigma gastrin) were measured in 170 consecutive patients with duodenal ulcers. Within both acid normosecretor and hypersecretor groups, patients with positive family history of ulcer dyspepsia had significantly higher mean maximal acid output than did those without such history. In early-onset (symptoms before age 30) but not late-onset (symptoms after age 30) patients, mean sigma gastrin was significantly greater in those with positive than in those with negative family histories, and in normosecretors than in hypersecretors. Among early-onset patients, family-history-positive normosecretors had a significantly positive correlation between maximal acid output and sigma gastrin, whereas family-history-positive hypersecretors had a significantly negative correlation between these variables. Thus, two subgroups of familial ulcers were identified among early-onset patients. A drive mainly on the G cells may be present in the former group, whereas a drive mainly on the parietal cells may be present in the latter.