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The basal serum gastrin concentration and stimulated gastric acid secretion (MAO) were measured in 837 patients at Hiroshima University Hospital. The basal serum gastrin concentration was significantly higher in males than females in the control group (normal and atrophic gastritis) and it was similar in patients with duodenal (DU) and gastric ulcer (GU), while MAO was significantly higher in males than females in all the groups. The basal serum gastrin concentration increased and MAO decreased with age in the control group. In patients with DU and GU the basal serum gastrin concentration did not change but MAO decreased with age. In patients with DU below 20 years of age, both the basal serum gastrin concentration and MAO were higher than those of age above 20, and were higher than those of the control group less than 20 years old. These findings may support the concept that in the control group increased gastrin release and decreased MAO with age result from achlorhydria or hypochlorhydria or from atrophy of the gastric mucosa; however, in patients with DU, especially in younger patients, gastrin plays a role in hypersecretion of gastric juice.

To determine the prevalence and significance of Helicobacter pylori (H. pylori) infection, biopsies of the antral mucosa were obtained from 139 patients and 43 asymptomatic volunteers. The specimens were examined by hematoxylin-eosin staining and the urease test. The detection rate of H. pylori by histologic examination was 91.3% in patients with duodenal ulcer, 75.0% in those with combined duodenal and gastric ulcer, 63.6% in those with gastric ulcer, 22.9% in those with gastric carcinoma, 36.4% in those with gastric adenoma, 14.3% in those with gastric hyperplastic polyp, and 51.7% in those with gastritis, and the respective percentages detected by the urease test were 91.3%, 75.0%, 54.5%, 28.6%, 27.3%, 14.3%, and 44.8%. H. pylori was also detected in 10/43 (23.3%) asymptomatic healthy volunteers by histology and the urease test. The prevalence of H. pylori was significantly higher in the patients than in the asymptomatic healthy volunteers (p < 0.05). H. pylori was detected in 62.9% of patients with endoscopic erosive gastritis and in 97.9% of those with histologically proven chronic active gastritis. The urease test was positive in 77/82 patients who were histologically positive for the organism (sensitivity: 93.9%), and it was negative in 98/100 patients who were negative by histology (specificity: 98.0%). Thus, there was over 90% agreement between the urease test and histology. Our investigations showed that H. pylori was closely related to peptic ulcers and antral gastritis, and that the urease test provides a simple, rapid and accurate diagnosis of H. pylori infection.

The antral somatostatin contents were investigated in biopsy specimens of the antrum from normal subjects and patients with duodenal ulcer. There was good correlation (r=0.77044) between antral somatostatin contents and maximal acidity in normal subjects, but the correlation between antral somatostatin contents and maximal acid output was not significant (r=0.254367). This result may indicate that antral somatostatin content is regulated by intragastric pH in normal subjects. On the other hands, no correlation was observed between antral somatostatin contents and acidity or acid output in patients with duodenal ulcer. Therefore the impaired regulation of acid on antral somatostatin contents could be one of the important factors in the pathogenesis of duodenal ulcer disease.

In order to examine the annual changes of peptic ulcer disease in Hiroshima District, a total number of 2548 patients with peptic ulcer were studied during the period from 1974 to 1983. From the results obtained, gastric ulcer (GU) was more common than duodenal ulcer (DU), and gastric ulcer combined with duodenal ulcer (GDU) was rare. The male to female ratio was 2.7 for GU, 5.0 for GDU and 3.4 for DU. There was a marked male preponderance in GU, GDU and DU. The male to female ratio of GU was surprisingly constant in all decades, while that of DU varied considerably between the different age groups, being on the highest 6.6 in the second decade. There was no marked annual change in GU to DU ratio during the period from 1977 to 1983. On the other hand, it was shown that the male preponderance pattern had changed gradually in both GU and DU.

To clarify genetic factors involved in the familial aggregation of duodenal ulcer, serum pepsinogen I levels were determined by radioimmunoassay in patients with duodenal ulcer and their affected and unaffected relatives. There existed relationship between an elevated pepsinogen I level and susceptability of duodenal ulcer, and the familial aggregation of duodenal ulcer. The segregation analysis revealed that hyperpepsinogenemia I was inherited as an autosomal dominant inheritance, and in some families this trait was responsible for familial aggregation of duodenal ulcer. But in other families normopepsinogenemic I duodenal ulcer has segregated and association to pathophysiological factors of this trait was obscure. These data provide evidence that genetic factors play a role in pathogenesis of duodenal ulcer, and that hyperpepsinogenemia I is one of genetic markers of this disease.