J.Jpn. Surg. Soc.. 87(9): 941-944, 1986

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Report on the annual meeting

PATHOPHYSIOLOGIC AND THERAPEUTIC INVESTIGATION OF POSTOPERATIVE STRESS ULCER IN PATIENTS WITH OBSTRUCTIVE JAUNDICE

Forty-eight of 659 patients with obstructive jaundice operated in our department manifested stress ulcer postoperatively. At present the prediction of postoperative stress ulcer remains difficult even by preoperative assessment such as gastric secretory test and the measurement of gastric mucosal potential difference (PD). According to experimental studies using rats, the weekened defensive mechanism, evidenced by the reductions of PD, gastric mucosal blood flow and gastric mucosal energy charge, plays a significant role in the manifestation of stress ulcer under the condition of obstructive jaundice. Other experiments suggest the biliary drainage effectively prevents the occurrence of gastric ulceration. Based upon these results, the postoperative monitoring of the intragastric pH and gastric mucosal PD were carried out clinically. The gastric mucosal PD showed a notable decrease in patients with obstructive jaundice after surgery. This measurement may make it possible to early predict the occurrence of the postoperative stress ulcer. Preoperative biliary drainage accompanied with the administration of antiulcer drugs is important to prevent the stress ulcer. When stress ulcer occurred, the adequate treatments including endoscopic hemostasis and surgery should be promptly carried out.

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