Gastric Ulcer

The mucous membrane of the body of the stomach and, to a lesser extent, that of the fundus produce acid and pepsin. The secretion of the antrum and pyloric canal is mucous and weakly alkaline.

Gastric ulcers occur in the alkaline-producing mucosa of the stomach, usually on or close to the lesser curvature. A chronic ulcer invades the muscular coats and, in time, involves the peritoneum so that the stomach adheres to neighboring structures. An ulcer situated on the posterior wall of the stomach may perforate into the lesser sac or become adherent to the pancreas. Erosion of the pancreas produces pain referred to the back. The splenic artery runs along the upper border of the pancreas, and erosion of this artery may produce fatal hemorrhage.

A penetrating ulcer of the anterior stomach wall may result in the escape of stomach contents into the greater sac, producing diffuse peritonitis. The anterior stomach wall may, however, adhere to the liver, and the chronic ulcer may penetrate the liver substance.

The secretion of acid and pepsin is controlled by two mechanisms: nervous and hormonal. The vagus nerves are responsible for the nervous control, and the hormone gastrin, produced by the antral mucosa, is responsible for the hormonal control.

In the surgical treatment of chronic gastric and duodenal ulcers, attempts are made to reduce the amount of acid secretion by sectioning the vagus nerves (vagotomy) and by removing the gastrin-bearing area of mucosa, the antrum (partial gastrectomy).