Frontiers of Gastrointestinal Research. The Stomach 6 Editor L.van der Reis. San Francisco. Calif. S. Karger Basel Mnchen Paris London New York Sydney

Transcription

1 Frontiers of Gastrointestinal Research The Stomach 6 Editor L.van der Reis. San Francisco. Calif. S. Karger Basel Mnchen Paris London New York Sydney ISBN The Stomach Frontiers of Gastrointestinal Research Vol. 6 Series Editor Leo van der Reis, San Francisco, Calif. Editorial Board J.H. Fisher, San Francisco, Calif.;H.P. Lazar, Chicago, Ill.; S.H. Lorber, Philadelphia, Pa.; D. W. Piper, Sydney; TN Tytgat, Amsterdam; W.M. Weinstein, Los Angeles, Calif. S. Karger Basel Mnchen Paris London New York Sydney The Stomach Volume Editor Leo van der Reis, San Francisco, Calif. 51 figures and 11 tables, 1980 S. Karger Basel Mnchen. Paris London New York Sydney Frontiers of Gastrointestinal Research Vol. 1: Immune Disorder. Ed. Leo van der Reis (San Francisco, Calif.) X p., 21 fig., 8 tab., ISBN Vol. 2: Enzymology of the Liver. Ed. Leo van der Reis (San Francisco, Calif.) XIV p., 20 fig., 39 tab., ISBN Vol. 3: The Esophagus. Ed. Leo van der Reis (San Francisco, Calif.) X p., 19 fig., 11 tab., ISBN Vol. 4: Gastrointestinal Cancer: Advances in Basic Research. Selected Papers of the International Conference on Gastrointestinal Cancer, Tel-Aviv, Eds. P. Rozen; S. Eidelman, and T. Gilat (Tel-Aviv) XIV p., 56 fig., 57 tab., ISBN Vol. 5: Gastrointestinal Cancer: Advances in Diagnostic Techniques and Therapy. Selected Papers of the International Conference on Gastroinestinal Cancer, Tel-Aviv, Eds. P. Rozen; S. Ewdelman, and T. Gilat (Tel-Aviv) XIV p., 72 fig., 86 tab., ISBN National Library of Medicine, Cataloging in Publication The Stomach

2 Volume editor, Leo van der Reis. - Basel, New York, Karger, c1980. (Frontiers of gastrointestinal research; v. 6) 1. Stomach - physiopathology I. van der Reis, Leo, ed. II. Series WI FR946E v.6/wi 300 S876 ISBN All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, oo by any information storage and retrieval system, without permission in writing from the publisher. Copyright 1980 by S. Karger AG, P.O.Box, CH-4009 Basel (Switzerland) ISBN Contents Foreword XI Structure and Infrastructure D. W. Day, Liverpool and B.C. Morson, London Gross Anatomy.1 Light Microscopy of the Gastric Mucosa.3 Cardiac Mucosa.3 Body Mucosa.3 Pyloric Mucosa.4 Transitional Mucosa Electron Microscopy of the Gastric Mucosa 6 Mucous Cells.7 Mucous Neck Cells.9 Parietal Cells.11 Chief Cells.13 Endocrine Cells.13 References Gastric Secretion and the Use of Cellular and Subcellular Systems in Gastric Research T. Berglindh, Birmingham, Ala..20 Introduction.20 Mucus Secretion.20 Gastrin Release.21 HCO3- Secretion.23 Pepsin Secretion.25 Acid Secretion 26 Lessons from Isolated Cell Systems 28 Localization of the Acid-Secreting Cell of the Stomach28 Contents VI Hormonal Stimulation of Acid Secretion.28

3 Secretagogue Response in Glands and Cells.29 Intracellular Mechanisms for Acid Secretion.30 References.31 Gastric Motility R. C. Heading, Edinburgh.35 Electrophysiology of Gastric Muscle.35 The Slow Wave.35 Action Potentials.37 Factors Influencing the Occurrence of Contraction..37 Antro-Duodenal Coordination38 Receptive and Adaptive Relaxation..38 Gastric Contractions and Emptying The Pylorus.41 Measurements of Gastric Motility and Emptying42 Radiological Procedures..42 Intubation Methods..43 Scintigraphic Methods...43 Normal Gastric Emptying...44 The Early Phase...45 Regulation of Gastric Emptying...46 Osmolarity..46 Acid..46 Fats...47 Amino Acids...47 Energy Density...47 Intragastric Volume...47 Posture...47 Interrelationships of Regulatory Systems..48 Gastric Emptying in Disease States...48 Gastric Hypo- and Hyperchlorhydria..48 Duodenal Ulcer..48 Gastric Ulcer...49 Gastric Cancer...49 Oesophagitis...49 Malabsorptive States...49 Diabetes mellitus...49 Other Causes of Gastric Stasis...50 Effects of Gastric Surgery on Emptying..50 Proximal Gastric Vagotomy (Highly Selective Vagotomy)..50 Truncal Vagotomy and Pyloroplasty 50 Partial Gastrectomy..51 Pharmacological Modification of Gastric Emptying..52

4 Gastric Emptying and Intestinal Absorption..52 Summary..52 References...53 Contents VII The Epidemiology and Pathogenesis of Gastric Ulcer R.H. Hunt and G.J. Milton-Thompson, Haslar/Gosport.. 57 Introduction..57 Epidemiology...58 Incidence...58 Genetic Factors...60 Social Class and Occupation..60 Dietary and Environmental Factors.. 60 Diet...60 Alcohol...61 Other Beverages..61 Smoking...61 Drugs...61 Association of Gastric Ulcer with Other Diseases..62 Pathophysiology...62 Vascular Factors...62 Mucosal Barrier Gastritis Luminal Factors - Acid, Pepsin and Mucus..64 Bile Drugs...65 Smoking...65 Conclusion...66 References...66 Epidemiology and Pathogenesis of Gastric Cancer K. Kawai, M. Kizu and T. Miyaoka, Kyoto..71 Epidemiology Trends in Gastric Cancer Sex and Age Distribution Geographical Distribution Racial Susceptibility and Observations in Immigrants Diets and Table Luxuries Socioeconomic Status and Occupations Genetic Profile Summary...78 Pathogenesis General Concepts Participation of Benign Gastric Lesions..80

5 (a) Peptic Ulcer...80 (b) Gastric Polyps...81 (c) Chronic Atrophic Gastritis Pathogenesis Derived from Experimentally Produced Gastric Cancer in Animals 83 (a) Gastric Ulcer...83 (b) Gastric Polyps...83 Summary...84 References...84 Contents VIII Non-Epithelial Malignancies of the Stomach S.P. Bralow, Sarasota, Fla...87 Introduction..87 Epidemiology and Environmental Factors..87 Classification of Non-Epithelial Malignancies.. 89 Malignant Lymphoma.. 91 Brill-Symmers Lymphoma.. 94 Smooth Muscle Tumors..94 Extramedullary Plasmacytoma of the Stomach...95 Glomus Tumors of the Stomach.. 95 References The Epidemiology and Pathogenesis of Chronic Gastritis: Three Etiologic Entities P. Correa, New Orleans, La..98 Introduction.. 98 Autoimmune Chronic Gastritis.. 99 Hypersecretory Chronic Gastritis Environmental Chronic Gastritis Conclusions References..107 The Treatment of Chronic Peptic Ulcer D. W. Piper, Sydney...l09 Initial Healing Measures that Accelerate Initial Ulcer Healing..109 Newer Methods of Treatment of Peptic Ulcer..111 Measures that Exert No Beneficial Effect on the Healing Rate of Chronic Peptic Ulcer..112 Approach to the Patient Who Presents with Chronic Peptic Ulcer Assessment of Healing The Problem of the Patient Whose Ulcer is Slow to Heal or Does not Heal Long-Term Management of Chronic Peptic Ulcer Treatment of Complications..116 Acute Gastrointestinal Haemorrhage

6 Parapyloric Stenosis..117 Hour-Glass Deformity and Perforation Surgical Treatment of Chronic Peptic Ulcer 118 Role of Endogenous and Exogenous Factors in the Aetiology, Course and Incidence of Complications in Chronic Peptic Ulcer References Contents IX Surgical Therapy of Gastric Ulcer 1. Alexander-Williams, Birmingham..126 Possible Causes of Gastric Ulcer Principles of Surgical Therapy..127 Different Types of Gastric Ulcer Practical Aspects of Operative Management Gastric Resection Vagal Section Surgical Techniques Gastric Resection..131 Intubation or Gastrectomy The Use of Antibiotics in Gastric Surgery Complications of Gastric Ulcer Haemorrhage Perforation..134 The Future Summary References The Diagnosis and Treatment of Gastric Malignancies C.J. Lightdale and P. Sherlock, New York, N.Y Adenocarcinoma of the Stomach..138 Gastric Lymphoma Leiomyosarcomas..145 Other Gastric Malignancies..145 References New Aspects on Epidemiology, Genetics, and Dynamics of Chronic Gastritis M. Siurala, K. Varis and M. Kekki, Helsinki..148 Classification of Gastritis Epidemiology of Chronic Gastritis..150 Prevalence of Gastritis Age Distribution of Gastritis Dynamics of Gastritis in Population Samples..153 Application of Dynamic Mathematical Methods to Study of the General Behavior of Gastritis..154

7 Dynamics of Gastritis in First-Degree Relatives of Probands with Severe Atrophic Gastritis and Overt Pernicious Anemia Dynamics of Gastritis in First-Degree Relatives of Gastric Carcinoma Patients161 Dynamics of Gastritis in Duodenal Ulcer Patients Dynamics of Gastritis in Operated Duodenal Ulcer Patients References..164 Contents X Epidemiology, Pathogenesis, Diagnosis and Treatment of Benign Gastric Tumours W. Rosch, Erlangen I. Introduction..167 II. Benign Epithelial Tumours and 'Polyps' Classification Epidemiology Pathogenesis and Malignant Potential of Gastric Polyps Diagnosis Therapy Ill. Non-Epithelial Gastric Tumours Epidemiology Pathogenesis and Pathologic Anatomy Diagnosis Therapy IV. Conclusion Summary References Subject Index Foreword I believe the material in the volume presents a fair delineation of the state of the art as it pertains to current concepts in gastrophysiology and pathophysiology. The material also demonstrates that progress has been and is being made in understanding the pathophysiologic processes of the stomach. It is quite clear that our understanding of these disease processes is limited and this is reflected in the surgical and medical armamentarium for the treatment of gastric disorders. Diagnostic techniques have improved, but even greater refinements are needed, and even then only time will tell whether or not they can make a significant contribution to more effective treatment and longer survival of patients with diseases of the stomach. I trust that this volume will be of interest to physicians, young and old, surgeons and non-surgeons. Leo van der Reis, MD Editor in Chief

8