J.Jpn. Surg. Soc.. 57(2): 260-276, 1956

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FUNCTION OF THE PYLORIC ANTRUM

In gastric and duodenal ulcers, the main object of surgical treatment is to cut down the acidity of gastric secretion. Therefore, a large area of the stomach including the pyloric antrum is removed in order to decrease the acidity. Great importance has been placed on the function of the main gastric glands but the function of the area around the pylorus which is the trigger to the gastric phase should not be overlooked. Resection of a small area of the lower region of the stomach around the antrum often leads to a decrease or even no acid secretion. This may be caused by the functionary absence of the trigger to the gastric phase but on the other hand this could occur by a secondary mechanical influence on the gastric glands causing a decrease in secretion.
To study the function of the remaining gastric glands after resection of the antrum, histopathological studies of the gastric mucosa of patients with gastric, duodenal ulcers, gastric cancer and experimental animals (dogs) were made.
In cases of gastric cancer with infiltration and degeneration of the mucosa of the pyloric antrum, generalized atrophic degeneration was seen over a large area of the non-cancerous glands. In ulcers where marked signs of chronic gastric changes were seen in the pylorus, there were too atrophic degenerative changes with malfunction in secretion was seen in glands far from the site. Resection of the antrum in dogs does not cause inflammatory changes histopathologically in the remaining part of the stomach even when examined at intervals over a period of time, but atrophic degeneration was seen which is similar to the changes of the gastric glands of the stomach in gastric cancer. In other words the generalized atrophic gastric changes seen in gastric cancer is not the result of inflammation but is believed to be atrophic changes of the gastric glands caused secondary to the loss of irritation from the trigger gastric phase.
Surgical gastrectomy for ulcers is not merely to do away with the trigger to the gastric phase and to cut down the hydrochloric secretion of the corpus but since it causes a secondary change in the remaining gastric mucosa the author believes that the basic concept of resecting a large area should be reevaluated.
(author's abstract)

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