J.Jpn. Surg. Soc.. 59(3): 382-403, 1958

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AN EXPERIMENTAL STUDY ON THE PATHOGENETIC SIGNIFICANCE OF HYDROCHLORIC ACID IN GASTRIC ULCER

The significance of hydrochloric acid (as a corrosive factor or inflammatory factor) in the pathogenesis of gastric ulcer in human is not yet established. Prof. Tomoda, in the review of his previous experiments in this direction, has thought that, though some considerations were given to the influence operation or to a certain metabolic disturbance, metabolic disturbances as a whole were insufficiently countered in those series of experiments. Consequently he has been lead to the view that such experiments should be conducted under prevention of influences as hunger, operation or narcosis and still more under prevention of metabolic disturbances which may be causative of ulcer.
From this view point the author has conducted, preventing metabolic disturbances as acidosis, vitamin-,protein-, calcium-deficiency which may be causative of ulcer, experiments in which solution of HCl-pepsin (0.5%, high concentrated but still within physiological range) and dog stomach juice (0.4 to 0.49% in HCl concentration) obtained by injection of oil histamin were orally infused into other dog stomach with the speed of 5.7 to 100cc/kg/hr. during 24 hours. Also to human stomach 0.5 to 0.55% HCI or HCl-pepsin solution was infused in which the same considerations as described above were given.
The histological findings of the gastric and duodenal mucosa obtained in these experiments were inflammation and necrosis of the epithelium. But in the experiments in which HCl-pepsin solution was infused into dog stomach or in which dog stomach juice was infused into the other dog stomach, necrosis of the epithelium was found also in the mucosa of fundic glandullar area, where ulcer does not develop in human. The author has observed in the same experiments described above acute inflammation (identical with the description of Konjetzny in heman resected stomach) seemingly resulting from the action of HCl but not following necrosis. According to Konjetzny and Tomoda necrosis of the epithelium was rarely found in the histology of human resected stomach preparates, and the author, in his experiments in which HCI or HCl-pepsin solution was infused in human stomach, also did not observe necrosis of epithelium resulting from the infused solution. These findings lead to the view that HCl may act as inflammatory factor but not corrosive factor in the pathogenesis of human gastric ulcer.
In the author's infusion experiments in dogs, macroscopic erosions or ulcers were all localized in the mucosa of pyloric glandullar area (in 3 out of 10 in HCl-pepsin infusion group, and in 4 out 10 stomach juice infusion group) and microscopic changes (inflammation and necrosis were more severe in the mucosa of pyloric glandullar area and of the duodenum than in the mucosa of fundic glandullar area. These findings, when combined with the data of electrochemical study of gastric mucosa against the actin of HCl carried out by Kato, Okumura and Koga in Tomoda's Clinic, suggest that the mucsa of the pyloric glandullar area and of the duodenum are less resistent to hydrochloric acid than that of fundic glandullar area.
(author's abstract)

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