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Background and Aim: Functional dyspepsia (FD) is a common condition seen in primary gastroenterology practice. The present study was conducted to compare the clinical effectiveness of mosapride and teprenone in patients with FD. Methods: Prospective clinical comparative study with random allocation of open labeled medications was performed as a multicenter trial in Japan. 1042 patients presenting symptoms of FD, either with gastric stasis (GSS) and/or epigastric pain (EPS), were enrolled. After initial endoscopic evaluation, medication either with mosapride 5 mg tid or teprenone 50 mg tid was started. Severity and frequency of GSS and EPS, health-related quality of life (HR-QOL) by the SF-36 Japanese version, and patients' compliance to medication was evaluated. Results: Organic lesions were found in 90 patients (9%) in the 1027 patients examined by endoscopy. Among those without any specific lesions detected by endoscopy, gastrointestinal symptoms were resolved within one week after the endoscopy in 264 (28%) patients before initiating medication. 618 patients who remained symptomatic were randomized to medication either with mosapride (n = 311) or teprenone (n = 307). Two-week treatment with mosapride significantly improved GSS and EPS, while teprenone tended to improve only GSS. Mosapride also improved HR-QOL. 91% of patients treated with mosapride favored their medication, while only 52% of patients treated with teprenone favored their medication. Conclusions: Endoscopic evaluation at patients' presentation was effective to find active lesions and to improve FD symptoms. Mosapride was more favorably accepted than teprenone by the patients with sufficient safety and efficacy.

症例は84歳男性．主訴は心窩部～右胸部痛と呼吸困難．腹部造影CTで肝右葉に3.5 cmの多血性腫瘍とそこから連続する不整形の低吸収域を認め，肝細胞癌破裂による腫瘍内出血と肝実質内出血，それに伴う肝内血腫形成と診断した．HCVとHBVはいずれも陰性で，画像上は軽度の慢性肝疾患変化を認めた．経カテーテル肝動脈塞栓術（TAE）を患者が拒否したため，安静と止血剤投与で経過観察をした．肝内血腫は徐々に小さくなり2カ月後にはほぼ消失したが，腫瘍内出血のため縮小したと考えられる腫瘍実質部は増大を示した．肝細胞癌に対する治療を再度勧めたところ，TAEを希望したため腹部血管造影を施行．肝右葉に腫瘍濃染像を認め，TAEを施行し18カ月後の現在まで再発を認めていない．肝細胞癌破裂により肝内に巨大血腫を形成することは稀であるが，本症例では背景肝が肝硬変でないことが血腫を形成する要因であったことが示唆される．

A 78 year old man suffering from anaphylactoid purpura complained of abdominal pain and bloody stools. Combined therapy with Prednisolone and cyclophosphamide had been given against nephrotic syndrome caused by purpura nephritis. Severe abdominal pain with symptoms and signs of pan-peritonitis necessitated laparotomy. Rectosigmoid perforation due to necrotizing angiitis (phlebitis) was also demonstrated histologically. The patient died of septicemia 18 days after surgery. Perforation of the alimentary tract rarely occurs in anaphylactoid purpura. Twenty similar cases were briefly reviewed from the Japanese literature.

Background and Goals: The prevalence of irritable bowel syndrome (IBS) among Japanese patients who visit hospitals departments of internal medicine is thought to be high. However, no clear statistical evidence has been provided to support such a claim. We tested the hypotheses that the prevalence of IBS in medical outpatients clinics in Japan is high, and that IBS patients feel more psychosocial stress than patients without IBS. Study: The subjects in this study were 633 patients who visited participating physicians. Patients were asked to fill in the Japanese version of the Rome II Modular Questionnaire (RIIMQ) for IBS diagnosis, the Self-reported Irritable Bowel Syndrome Questionnaire (SIBSQ) for severity of the disease and the demographic questionnaire for perceived stress and life style. Results: Rome II-defined IBS was diagnosed in 196 patients (31%). Analysis of variance revealed significant difference in the IBS scores of SIBSQ among IBS subjects (39.0 ± 11.1, mean ± SD), functional bowel disorder subjects (27.1 ± 10.2), and normal subjects (24.0 ± 10.0, P < 0.01). The prevalence of IBS depending on age formed 2 peaks, one among adolescents and the other among the elderly. IBS patients had significantly more perceived stress (P < 0.0001), irregular sleep habit (P < 0.0001), and irregular meal habit (P < 0.0001) than those without IBS. Conclusions: The prevalence of IBS among medical outpatients in Japan is high (31%). IBS subjects among medically ill patients are thought to have more perceived stress and less regular life styles.

Objectives: To investigate the efficacies of two different triple-therapy regimens (standard versus low doses), and the influence of cytochrome P450 enzyme (CYP) genetic polymorphism on these efficacies, in Japanese patients undergoing Helicobacter pylori eradication treatment. Methods: All patients received 1 week of triple therapy. Patients in group A (low-dose regimen) received omeprazole 40 mg/day + amoxicillin 1500 mg/day + clarithromycin 800 mg/day; patients in group B (standard-dose regimen) received omeprazole 40 mg/day + amoxicillin 2000 mg/day + clarithromycin 1000 mg/day. Results: A total of 225 patients (113 in group A and 112 in group B) were randomised to one of the two triple-therapy regimens. The eradication rates were 78.8% (89/113 patients; 95% CI 70.1, 85.9) in group A and 83.0% (93/112 patients; 95% CI 74.8, 89.5) in group B. Genetic polymorphism of CYP2C19, a major metabolic enzyme of omeprazole, did not affect eradication rates, while susceptibility to clarithromycin greatly affected the success of eradication. The cumulative ulcer relapse rate at 24 weeks after endoscopically documented ulcer healing (30 weeks after completion of the drug regimen) was 8.3% for group A and 12.5% for group B (log rank test: p = 0.6248). However, comparison of the cumulative relapse rate of 6.7% in patients after successful H. pylori eradication with the relapse rate of 27.3% in those who failed H. pylori eradication revealed a significant difference in the remission-time curve (log rank test: p = 0.0047). This finding suggested the existence of a relationship between H. pylori eradication failure and ulcer relapse. Both drug regimens were well tolerated. Endoscopically proven reflux esophagitis developed in about 10% of patients after eradication, but was not clinically significant. Conclusions: One week of triple therapy with a low-dose regimen provides adequate H. pylori eradication in Japanese patients. CYP genetic polymorphism is of minimal clinical significance with both triple-therapy regimens.

We investigated the peptic ulcer recurrence rates during maintenance therapy with H2-receptor antagonists (H2RAs) following first-line therapy with a proton pump inhibitor (PPI). Patients with gastric ulcer (GU) or duodenal ulcer (DU) were enrolled in this study; 583 eligible patients (GU, 325; DU, 258) were administered lansoprazole (30 mg/day for 8 weeks for GU, and the same dosage for 6 weeks for DU) as first-line therapy, and a half dose of H2RA as maintenance therapy for 12 months. Endoscopic photographs were taken before administration and after 8 (GU) and 6 (DU) weeks of lansoprazole administration. Ulcer stage was evaluated using the classification of Sakita and Miwa. Endoscopic examinations were performed 6 months or 12 months after the start of maintenance therapy or when a recurrence was suspected because of the appearance of subjective symptoms. The healing rates for GU and DU patients after completion of lansoprazole therapy were 79% in both groups, while the S2-stage healing rates were 18% and 31%, respectively. At 1 year after the start of maintenance therapy, the recurrence rates were 25% for GU and 39% for DU patients. In DU patients, the recurrence rates from S1-stage and S2-stage were 49% and 20%, respectively (P = 0.004), but no significant difference was found between these rates in GU patients. The recurrence rates in H. pylori-positive patients before lansoprazole administration were 27% for GU and 43% for DU patients. We concluded that the maintenance therapy with a half-dose of H2RA following PPI therapy was insufficient to prevent recurrences of GU and DU.

逆流性食道炎は内視鏡的所見が正常であっても,胸やけなどの自覚症状があり,胃・食道逆流症(gastroesophagea1 reflux disease: GERD)を含めて広い意味で理解する必要がある.病態は酸逆流に起因しており,酸の亢進だけではなく,食道と胃の運動機能障害による,ある意味では機能性疾患である.治療は薬物療法が中心ではあるが,患者の日常生活における注意,食事の指導,併用薬の指導など,一般的治療が重要である.

Interleukin (IL)-8, a potent chemoattractant and activator of neutrophils, has been implicated to have a major role in the pathogenesis of gastric mucosal injury by Helicobacter pylori infection. We examined the relationship between cytotoxicity and IL-8 secretion induced by H. pylori. Furthermore, whether the vacuolating cytotoxin of H. pylori mediates IL-8 secretion from gastric epithelial cell lines was examined. Among the inflammatory cytokines, messages for IL-6, IL-8 and transforming growth factor-beta 1 were produced by gastric cancer (MKN45) cells in response to exposure to the cytotoxic strain of H. pylori. MKN45 incubated with the viable cytotoxic strain of H. pylori secreted IL-8. In contrast, the supernatant of neither the cytotoxic nor the non-cytotoxic strain induced IL-8 secretion. There was no correlation between IL-8 secretion and the intensity of cytotoxicity. In conclusion, these findings suggest that IL-8 secretion from MKN45 induced by H. pylori is mediated by factors other than cytotoxicity.

One of the features of Helicobacter pylori infection in the human stomach seems to be disordered gastric acid secretion. The effect of vacuolating toxin (VT) produced by H. pylori on gastric acid secretion was examined.VT(+)(toxigenic) and VT(-)(nontoxigenic) strains of H. pylori were cultured in brucella broth. The culture supernatant was added to isolated parietal cells, and acid secretion and intracellular adenosine 3'5'-cyclic phosphate (cAMP) and Ca2+ levels were measured with the 14C-aminopyrine (14C-AP) method, with 125I radioimmunoassay (RIA), and with the fura-2 fluorescence method, respectively.In the VT(+) strain a considerable inhibitory effect on 14C-AP accumulation was observed. However, the VT(-) strain had no significant effect on intracellular c-AMP and Ca2+.The VT(+) strain of H. pylori has an inhibitory effect on gastric acid secretion, whereas the VT(-) strain does not. This inhibitory effect was not associated with the response of second messengers. It is speculated that VT produced by H. pylori has a direct action on H(+)-K+ adenosine triphosphatase in parietal cells.

The recurrence-free rate and factors related to recurrence after healing were investigated in duodenal ulcer patients on H2-blocker maintenance therapy with famotidine. Famotidine maintenance therapy (20 or 40 mg once a day before bedtime) was performed in 488 evaluable patients after endoscopically-proven healing of ulcers (S1 or S2). The cumulative recurrence-free rates were 81.1%, 65.1% and 58.2%, respectively, after one, two and three years of maintenance therapy. Among various background factors, those which have been suggested to be closely associated with ulcer recurrence were compared on the basis of their relation to the recurrence-free rate. These factors included a past history of duodenal ulcer, smoking, alcohol use, bulbar deformation, the endoscopic stage of ulcer healing, concomitant drugs and compliance with famotidine therapy. Recurrence correlated most significantly with a past history of duodenal ulcer and with compliance. Compliance was categorized as excellent, good, fair or poor. The recurrence-free rate was significantly lower in patients with excellent compliance than in any other compliance group. A famotidine dose of 40 mg/day (the standard dose), versus the half dose of 20 mg/day, produced no significant difference in the cumulative recurrence-free rate and it was therefore suggested that 20 mg/day of famotidine is comparable to 40 mg/day in its preventive effect on duodenal ulcer recurrence. In addition, because recurrence was more common in patients who had previously experienced recurrence, a past history of ulcer was suggested to be a significant risk factor for ulcer recurrence.

To determine changes in pathophysiology during the healing process of gastric ulcers, gastric acid secretion, gastric emptying, fasting gastrin levels (FGL) and the integrated gastrin response (IGR) were studied in normal volunteers and in each stage of gastric ulcers. In a study of patients with gastric ulcers in the lesser curvature of the ventricular angulus including 20 in the active stage, 49 in the healing stage and 11 in the healed (scar) stage, gastric acid secretion (BAO and MAO) and FGL gradually decreased as the patients progressed from the active stage through the healing and healed stages. IGR values did not change, but gastric emptying showed marked prolongation in the active and healing stages although this was alleviated in the healed stage. In 11 of the same gastric ulcer patients who were followed up, gastric acid secretion, especially BAO, was lower in the healed stage than in the active stage. No fixed tendency was seen for gastric emptying and IGR, but FGL showed higher values in the active stage than in the healing stage. These findings indicated that changes in the pathophysiology of the stomach occur during the healing of gastric ulcers, and it was assumed that these changes are closely related to the stage of the ulcer.

目的:上部脊髄損傷患者の消化管合併症治療を目的に,病態の検索と検討を試みる.対象:11名の若年男性頸髄損傷患者と同年代の健常者で,内視鏡的に正常,胃潰瘍,十二指腸潰瘍と診断された3群を対象とした.方法:胃液検査,胃排出検査,内視鏡検査を行い患者群を健常者各群と比較検討した.結果:患者群の消化管機能は,胃分泌能が健常者正常群と胃潰瘍群より亢進し,胃排出能が健常者正常群と十二指腸潰瘍群より遅延し,健常者のどの群とも異なっていた.内視鏡検査では,胃病変を10名中7名に認めたが十二指腸病変は認めず,同年代の健常者の病変分布とは異なる結果であり,頸髄損傷患者の胃病変増加は,胃分泌亢進と胃排出遅延の関与が考えられた.

Functional dyspepsia (FD) is a common condition seen in primary gastroenterology practice. The present study was conducted to compare the clinical effectiveness of mosapride and teprenone in patients with FD.Prospective clinical comparative study with random allocation of open labeled medications was performed as a multicenter trial in Japan. 1042 patients presenting symptoms of FD, either with gastric stasis (GSS) and/or epigastric pain (EPS), were enrolled. After initial endoscopic evaluation, medication either with mosapride 5 mg tid or teprenone 50 mg tid was started. Severity and frequency of GSS and EPS, health-related quality of life (HR-QOL) by the SF-36 Japanese version, and patients' compliance to medication was evaluated.Organic lesions were found in 90 patients (9%) in the 1027 patients examined by endoscopy. Among those without any specific lesions detected by endoscopy, gastrointestinal symptoms were resolved within one week after the endoscopy in 264 (28%) patients before initiating medication. 618 patients who remained symptomatic were randomized to medication either with mosapride (n = 311) or teprenone (n = 307). Two-week treatment with mosapride significantly improved GSS and EPS, while teprenone tended to improve only GSS. Mosapride also improved HR-QOL. 91% of patients treated with mosapride favored their medication, while only 52% of patients treated with teprenone favored their medication.Endoscopic evaluation at patients' presentation was effective to find active lesions and to improve FD symptoms. Mosapride was more favorably accepted than teprenone by the patients with sufficient safety and efficacy.

A 58-year-old male was admitted to our hospital complaining of perineal pain and weight loss. On digital examination, a hard mass with a central depression was palpable in the circumference of the rectum. A barium enema study revealed a giant periproctal abscess formation, and a colonoscopy showed a giant irregular-shaped ulceration in the circumference of the rectum. Biopsy specimens obtained from the rectal ulcer revealed a well differentiated adenocarcinoma, and this case was diagnosed as being carcinoma of the rectum with periproctal abscess formation. A pelvic exenteration and colostomy were performed. The macroscopic findings of the resected rectal specimen showed a giant abscess formation measuring 13 cm over the anal verge in the circumference of the lower rectum. The abscess, with a thickened wall measuring 50 mm, was accompanied by an ulcerated lesion on its oral and anal side. The tumor was adherent to the bladder and prostate with direct invasion. The post operative diagnosis made was an unclassified type of rectal carcinoma (type 5). Its clinical staging was stage 5 (HIPON1A3) in gross appearance. The histopathological findings of the resected specimen indicated a poorly differentiated adenocarcinoma partly containing signet ring cell carcinoma. The frequency with which a rectal carcinoma with a regional abscess has been reported is less than 1%. It has been assumed that a regional abscess is caused by the perforation of the rectum contributing with the invasion of carcinoma over the proper muscle layer. In this case, it was inferred that the rapid development of this tumor caused secondary, ischemia at its center and then an abscess was formed with tumor necrosis.

In 240 patients with symptoms of dyspepsia, recruited consecutively and investigated in 12 hospitals in Japan, 24.2% were diagnosed having organic dyspepsia; 75.8% had functional dyspepsia, of whom 63.2% were diagnosed by the investigator having dysmotility-like, 13.7% ulcer-like, 11.5% reflux-like, and 11.5% non-specific dyspepsia. There was, however, considerable overlap of symptom profiles. Cisapride therapy initiated in functional dyspeptic patients resulted in moderate or marked improvement in 79.1% of the patients with the highest response rates for dysmotility-like (85.2%), reflux-like (81.0%), and non-specific dyspepsia (76.1%) (versus 52.0% for ulcer-like dyspepsia).

Background: Irritable bowel syndrome (IBS) is a common gastrointestinal disorder. Serotonin type 3 (5-HT3) receptor antagonist alosetron hydrochloride is indicated for women with chronic, severe diarrhea-predominant IBS who have not responded adequately to conventional therapy. However, whether or not the therapeutic efficacy of 5-HT3 receptor antagonists has gender difference is uncertain. Methods: A double-blind, placebo-controlled, parallel-group, comparative study was conducted to evaluate the effect of novel 5-HT3 receptor antagonist, ramosetron hydrochloride, in male and female patients with diarrhea-predominant IBS. 418 subjects were randomized (109 subjects: placebo, 105 subjects: 1 µg, 103 subjects: 5 µg, and 101 subjects: 10 µg) and administered the study drug once daily. Results: The monthly responder rates of ‘Patient-reported global assessment of relief of irritable bowel syndrome symptoms’ in the 5- and 10-µg ramosetron hydrochloride-administered groups were higher than the placebo group (26.92, 42.57, and 43.01% for placebo, 5 and 10 µg). Moreover, the difference of the responder rate in comparison with the placebo group was similar in males and females. As for safety, there was tolerability at doses up to 10 µg. Conclusion: Ramosetron is an effective and well-tolerated treatment not only for female IBS patients but also for male patients.

Irritable bowel syndrome is characterized by abdominal discomfort and/or pain associated with altered bowel habits. The neurotransmitter serotonin and serotonin type 3 receptors that are extensively distributed on enteric neurons in the human gastrointestinal tract play a role in increasing the sensation of pain and affecting bowel habits in patients with irritable bowel syndrome. The aim of this study was to evaluate the efficacy and safety of the serotonin type 3 receptor antagonist ramosetron hydrochloride in Japanese patients with diarrhea-predominant irritable bowel syndrome.In a double-blind, placebo-controlled, parallel group-comparative study with a 1-week run-in period, 539 patients with diarrhea-predominant irritable bowel syndrome meeting the Rome II diagnostic criteria received either 5 microg ramosetron hydrochloride (n=270) or placebo (n=269) once daily for 12 weeks.Forty-seven percent of ramosetron hydrochloride-treated patients were monthly responders in the primary end-point, "Patient-reported global assessment of relief of irritable bowel syndrome symptoms", compared with 27% for placebos (p0.001). The most frequently reported adverse event in the ramosetron hydrochloride-treated group compared with the placebo group was hard stool.Ramosetron hydrochloride 5 microg once daily is effective and well tolerated in the treatment of abdominal pain, discomfort and bowel habits in patients with diarrhea-predominant irritable bowel syndrome.

In the comparison of bacteriological and histological methods, the rapid urease (RU) test was considered a specific (100%) method for detection of Campylobacter Pylori (Cp), by which the presence of Cp can be rapidly judged (more than 90% in 20 min.). For an accurate and reliable diagnosis, other methods should be used concurrently, because the sensitivity of this test was inferior to bacteriological methods by 10 to 20%. In the histological study, polymorphonuclear leukocyte infiltration in the antral mucosa clearly reflected Cp infection. This pathological change responded well to antibacterial therapy. Of some endoscopic findings in the gastric antrum, verrucous change was considered to have a relatively close association with Cp infection. However, about 30% of Cp-present cases had endoscopically no abnormal appearance in the gastric antrum.

Helicobacter pylori eradication therapy combining amoxicillin (AMPC), plaunotol (PL), and a proton pump inhibitor (PPI) was examined as an alternative to triple therapy, which has a high rate of side effects and low patient compliance. Thirty-two H. pylori-positive patients (24 men, 8 women) with duodenal ulcers were examined. The diagnosis of H. pylori infection was made by the urease test on specimens biopsied from two sites in the stomach. Simultaneously, the IgG antibody against H. pylori was measured by the EIA method. The therapeutic regimen was lansoprazole (LPZ) 30 mg q.d. (6 weeks) and AMPC 1,500 mg t.i.d. (2 weeks) plus PL320 mg b.i.d. (6 weeks). The rate of ulcer healing was judged endoscopically after 6 weeks. Cases that become urease-negative after the cessation of the therapy were defined as having achieved clearance, and those negative after I month as eradication. Within 6 weeks, 31 of 32 patients had healed ulcers. All patients were H. pylori antibody-positive before therapy. The clearance rate was 71.9% (23/32) and the eradication rate was 45.8% (11/24). Adverse effects were observed only in one case. We conclude that combination therapy with LPZ, AMPC, and PL has a high therapeutic effect on ulcer healing and moderate effectiveness for eradication of H. pylori.

active gastritis, dysplasia, or cancer. Results: The 1010 identified cases had a mean age of 50 ± 14 and included 618 (61%) women, 549 (54%) Hispanics, 283 (28%) Asians, 68 (7%) Blacks, and 55 (5%) Whites. Significant esophageal pathology (EP) was uncovered in 186 (18%) individuals and significant gastric pathology (GP) in 114 (11%), including PUD in 35 (3.5%). More men had EP than women (22% vs 16%; p=0.008). However, women born in the US were more likely to have EP than those who immigrated to the US (36% vs 14%; p=0.004). Hispanic women were more likely to have EP than non-Hispanics (17% vs 11%; p=0.046). Men had more GP than women (15% vs 9%; p=0.001). Blacks were more likely to have GP than non-Blacks (21% vs 11%; p=0.013), including a higher rate of PUD (8.8% vs 3.2%; p=0.03), despite no difference in H. pylori prevalence (47% vs 45%; p=0.47). Asians were also more likely to have GP than non-Asians (17% vs 9%; p

We investigated the relationship between apoptosis and gastric epithelial ceils infected with Helicobacter pylori (H. pylori). Patients: Patients examined with included 24 with gastric ulcer(GU), 30 with duodenal ulcer(DU), and 7 with gastric and duodenal ulcer(GDU). The diagnosis was endoscopically determined, and H. pylori infection was confirmed either by bacterial culture or by histological examination. The control group consisted of 5 healthy volunteers. Methods: At endoscpical examination, six biopsy specimens were obtained from the stomach. Three were used for the apoptosis study, (the epithelial cells were fixed with 75% ethanol stained with Propidium Iodine and apoptotic ceils were determined by flowcytometry). The other three were used for a bacterial culture (H. pylori No. VTassay, Urease assay) and histological examination(gastritis score). Results: The percentages of apoptotic in the gastric epithelial ceils in GU, DU, GDU and healthy volunteers were 21.2_2.1%, 21.4±2.3%, 17.0_3.1%, and 7.4-+2.0% respectively. Statistical significance was noted between the ceils from the total H. pylori -positive patient group and those from the healthy volunteers (p < 0.05). Interestingly, the percentage of apoptosis in the cells from the DU patients in the active stage was significantly higher than those from DU patients in healing and scar stages. (30.3 -+ 4.8% vs 19.7 -+ 4.2% 16.9 -+ 2.3 p < 0.01). The percentage of apoptotic cells did not differ significantly between patients with different histological score, No. of H. pylori and VTassay. The percentage of apoptotic cells was correlated with urease activity. Conclusion: Apoptosis in the gastric epithelial cells is correlated not only with H. pylori infection, but also with the stage of peptic ulcer. Thus, apoptosis may be a useful marker for the mucosal damage evoked by 1-1. pylori infection.

試験食として自然食を主とした流動食を用いたacetaminophen(以下APAPと略す)法で胃排出機能検査をおこない,服用後45分の血中APAP濃度(mcg/ml)をもつて胃排出能とした.消化性潰瘍の胃排出能,酸分泌能と胃排出能に検討を加え胃潰瘍と十二指腸潰瘍の相違を胃排出能の面から考察した.又消化性潰瘍の再発とそれぞれの潰瘍の胃排出能との関係についても検討した.活動期の胃潰瘍,十二指腸潰瘍の胃排出能はそれぞれ, 7.7±3.3mcg/ml, 11.3±3.4mcg/mlであり,健康正常者のそれは9.4±2.6mcg/mlであつた.胃潰瘍では明らかに胃排出能の遅延(p

Gastric metaplasia of the duodenal mucosa in biopsy specimens of healed duodenal ulcer and in surgical specimens of perforated duodenal ulcer was investigated using mucin histochemistry and the indirect immunoperoxidase method. Endoscopic methylene blue test was performed prior to biopsy. All specimens from areas showing no dye absorption revealed varying degrees of gastric metaplasia characterized by heterotopic occurrence of gastric-type foveolar cells mainly at the tips of stunted intestinal villi. On average, 31.8% of the total surface length of duodenal mucosa taken from areas showing no dye absorption was occupied by the metaplastic cells. They showed strong reactivities for periodic acid-Schiff (PAS) and galactose oxidase-Schiff sequences, while alcian blue and paradoxical concanavalin A staining, class III, were negative. Immunoperoxidase-PAS double staining revealed a few gastrin and somatostatin cells in foci of gastric metaplasia, but almost no cells containing motilin, secretin, cholecystokinin and gastric inhibitory peptide. Such endocrine cells were scattered in nonmetaplastic mucosa. While such metaplastic change has been regarded as a self-defence mechanism or adaptation of the duodenal mucosa against acid, a local decrease of normal endocrine cells, which allegedly function as acid receptors, may lead to alterations of gastroduodenal interaction. It is suggested that gastric metaplasia is important as one of the pathophysiological mechanisms involved in the recurrence of duodenal ulcer. ACTA PATHOL JPN 38 : 1011 ∼ 1018, 1988.