Aspects of the pathogenesis and healing of gastric erosions and ulcers
Williams, Alun Wynn
For nearly a century the subject of peptic ulceration has fascinated and baffled investigators. The extent of the medical literature on various aspects of the ulcer problem indicates its complexity, while the chaos of conflicting experimental and clinical data points to the need for truly fundamental knowledge. This common and serious condition remains an enigma and although accumulated in- formation has led to improvements in treatment, the latter remains crude, unreliable and possibly associated with harmful complications.Popular opinion supports the naive suggestion that the problem is merely one of hyperchlorhydria but a critical survey of the literature shows that, in fact, very little progress has been made in our understanding of peptic ulceration as regards acidity or other factors such as vascularity, mucin or nerve -supply and it would therefore seem appropriate to broaden our conception of the patho- genesis. Is there any reason, for example, why one should assume a common causal pathway for all types of peptic ulcer. Three fundamental questions require an answer. They are: (1) what are the factors which cause ulcers, (2) which factors favour the localization of ulcers to certain sites and (3), what are the factors which maintain chronicity, viz. delay healing. In this investigation, special emphasis is placed on the aspect of healing of gastric, gastric erosions and ulcers. In man and animals, defects of the mucosa of stomach or duodenum are normally repaired rapidly but in patients with chronic peptic ulceration there is failure of an acute ulcer to heal. This failure, as Cohnheim (1882) first stressed, is the root of the problem. No -one has yet explained satisfactorily why it exists.Some people are critical of the use of animals for research into the pathogenesis of chronic peptic ulcer. They assume that, because spontaneous peptic ulcers are rare in animals, experimental results are not significant in relation to humans. However, from a controlled re- search point of view, such immunity from spontaneous ulceration is a major advantage. The results of animal experiments may or may not be of clinical importance but are, nevertheless, of general biological importance and interest.