Tohoku J. exp. Med., 1976, 118 (Suppl .), 39-43

Comparative

Study

between

Benign

of Early

Stomach

to Histological

on Gastric

Gastric

Polyp

Cancer Findings

with

Secretory and

Elevated

Special

of Gastric

Function Type

Reference

Mucosa

HIROYUKI SAKURADA, AKIRA ISHIMORI, HIROMICHI ARAKAWA, SUSUMU YAMAGATA, YOSHIKUNI MIURA , KATSUJI TSUDA, TAKESHI KAWAMURA and SHOICHI YAMAGATA

The Third Departmentof Internal Medicine,Tohoku University Schoolof Medicine,Sendai

SAKURADA, H., ISHIMORI, A., ARAKAWA, H., YAMAGATA,SU., MIURA, Y., TsuDA, K., KAWAMURA, T. and YAMAGATA,S. Comparative Study on Gastric Secretary Function between Benign Gastric Polyp and Elevated Type of Early Stomach Cancer with Special Reference to Histological Findings of Gastric Mueosa. Tohoku J. exp. Med., 1976, 118 (Suppl.), 39-43 In cases of elevated type of early cancer and benign polyp of the stomach, gastric analysis was performed and the results were compared with histological findings of gastric mucosa. Both clinical entities were found to show lowered acid and pepsin secretory functions reflecting severe and extensive atrophic changes of gastric mucosa. Dissociation in secre tory disturbance between acid and pepsin was also noticed. gastric polyp; early stomach cancer; mucosal atrophic change; pepsin

Both benign polyp and elevated type of early cancer of the stomach are known to be accompanied by mucosal atrophic changes of various degrees around the lesion (Cornet et al. 1971). However, the clinical course and prognosis of these elevated lesions are entirely different in these two pathological entities. Owing to difficulties in detecting gastric cancer of an early stage, pathophysio -logical differences between benign polyp and elevated type of early cancer of the stomach remain still obscure. The purpose of the present investigation is to compare gastric secretory functions in these two pathological entities and to relate the results to histological findings of gastric mucosa. MATERIALS AND METHODS Subjects. 28 cases of benign gastric polyp and 21 cases of early stomach cancer located near the angular incisure were chosen. The cases of elevated type of early cancer of the stomach consisted of 7 cases of type I and 14 cases of type IIa according to the classification of Japanese Endoscopic Society. Multiple specimens were obtained from the mucosa of the anterior and the posterior wall according to the rule of Ishimori et al. (1974) Received

for publication,

November

20,

1975.

40

H. Sakurada

et al.

for histological examination under fiberscopic control. Surgically removed stomachs were also used for the histological study in some cases. Gastric analysis. After the stomach was completely emptied through the perorally inserted gastric tube (Salem Sump Tube) in the early morning, basal secretion was collected by continuous suction for 1 hr and pooled every 10 min. Then 2 mg per kg of body weight of betazole hydrochloride was injected intramuscularly and gastric juice was collected in the same manner for another hour (Laudano and Roncoroni 1965). Each fraction was examined for volume, titratable acidity using a pH-stat and peptic activity according to a slightly modified method of Anson-Mirsky (1933). Proteolytic activity of gastric juice at pH 1.5 was expressed in mg of tyrosine produced from bovine hemoglobin in 1 min during the digestion experiment by 1 ml of native gastric juice. Basal pepsin output (BPO) and stimulated pepsin output (SPO) were estimated with the following formula.

where n is fraction number, M volume of gastric juice for each 10-min pooled specimen, P proteolytic activity of gastric juice for each 10-min pooled specimen. RESULTS The polyp

and

Only no

relationship

2

elevated

cases

of

secretory

maximal Acid

secretory

of

elevated was in

early

very both

1. Relationship elevated type

as

given.

low groups

of in

of

,

the

was

by

cancer

both

groups

the in

of .

is

both no

acid

pepsin

pathological acid

polyp

Achlorhydria

illustrated

difference

two

stomach

output

and

distinct

maximal

benign the

pepsin

stomach

between

n.=28)

early

basal

of

There

expressed

and

secretion

response

(mean±s.D. type

output

cancer

showed

was

function

incidence

acid

hydrochloride

mEq/hr in

basal

polyp

stimulation

function

Fig.

type benign

betazole

0.24•}0.86 (n=21)

between

was

benign

in

Fig.

, although (p>0 .5)

encountered

Acid

was

mEq/hr secretory in

a

high

.

between basal of early cancer

acid output and of the stomach .

basal

pepsi

n output

in .

(MAO)

0.85±0.16 1).

1.

conditions

output

and (Table

in

in polyp

and

Gastric

TABLE 1.

Fig. 2.

seen

in

values

and

18.9+14.2 .T he

absence

is illustrated patients

in who

showed

of

Fig. still

Cancer

41

elevated

type

not

It

function 32.26•}31.28

pepsin

2.

output and maximal stomach.

were

was

preserved

that

pepsin

absence

of

lower

acid

seen

early

acid

and

in

benign

than and

in polyp

both

groups.

polyp

(n=21)

(n=14) (p>0.1).

were

secretory

both

low in

cancer

output

there

acid output

also

statistically

maximal was

was Tyr.mg/hr

of

significant secretion

between

complete

comparable

in was

relationship

pepsin of the

pepsin-secretory

output

Tyr.mg/hr

of

The

in

1,

pepsin

difference

incidence

who

between stimulated type of early cancer

Table

of

and Stomach

Maximal acid output and stimulated pepsin output after maximal betazole hydrochloride stimulation in polyp and elevated type of early cancer of the stomach

Relationship and elevated

As Mean

Polyp

that

of

However, achlorhydria.

stimulated

relatively

function

in

pepsin

secretion

the

pepsin many

both

groups. were

output

achlorhydric Patients also

observed

numbers.

DISCUSSION

Early Society secretary the

cancer

of the

into five types. function

maximal

acid

stomach Among

not different output

as

has

them

been

the ulcerative

from that well

classified

as

in benign stimulated

by the Japanese

type has

been shown to reveal

ulcer of the pepsin

Endoscopic

stomach.

output

after

Namely, maximal

a

42

H. Sakurada

betazole

hydrochloride

( Ishimori

et

1974).

to

that

corresponds MAO

is

22.44

Tyr.

9.2•}

On

6.9

the

both

suggest

that

ulcer

or of

with

stomach

in

changes

around

ulcer

are

in

of

has ulcer On has

defect

in

discussed

and

polyp contrary also

by

above-mentioned

unction the

present

is

previous of

disclosed to

to

in

the

study

groups

the

with of

type.

previous may

link cancer

sug

from

elevated

our

stomach

early

study

have

some

benign

the

secretory

peptic

stomach

that

early

ulcer

function

may

and

and

and

less

gastric

pronounced

individual

the

variation

other hand, and elevated

extensive

in

the

gastric atrophic

cancer

become

On polyp

in

mucosal

gastric

marked

severe

of

histologically

reported of

however,

be

to

whether change

account

achylia

.

, further

should

acid

and

pepsin

the et

mucosal type of

generel

as

seen

and to

the

stomach

Geller

peptic

1951;

such

of

as

Konjetzny

digestion

development

of

gastric

ulcerative

tissue

of

Although

interpretation seems t ype of early cancer a et al . 1974). However, the present preserved acid and pep sin secretory f this

investigation in

be

of

al . 1971). This study on ulcerative

of cases

transformation

attention

(Klein

(Ishimori

a number

lesions

due

for

(Sakita

stomach

of

benign

formation

comparative

the

cases

malignant The

between

Bockus always

show

seen

other

with

the

al . 1974). in benign

both

cancer

interpretation of

the

observed

the

is, et

ulcer to

gastric

our

addition

polyp.

to

malignant

, benign

ulcer

study

possibility

of

been

There

as

undergo

of

peptic

in

polyp

present

distinct

and

of

type

found

widely

considered

cases

supported

unction

were

case,

199.36•}

endoscopically is

the

two

together

mass

has

(Ishimori lesion

benign with

with

into

concerning

cell

adjacent

the

is

.

It

.

and

difference

type

studies

ulcerative

lesion

stomach

the

some

comparative

n

cancer

latter

study.

been

benign

and

the

the

been

1913).

be

from early

function

the

output

patients

together

type

secretory

areas

around

present

peptic

nd

in

in

cancer the It

to

severe

of

pathophysiological

stomach

in

cancer

cancer

least

our

pepsin

essential

study

early

entities. lesion

changes

early

juice

clinical

that

classified

elevated

the

the

ulcer

distance

at

early

ulcerative

of

in

general

these

respect

atrophic

in

in

most

the this

of

obtained

reflect

mucosa

with

polyp

findings

is

present

the

of

1974)

be

one

type

while

al.

the

or

stomach,

link

The

ulcerative

In

conditions.

may

in

pathogenetic

the

a

et

stomach

conditions

secretory

1975).

with no

two

(Ishimori

the

obtained

the

etiological

these

viewpoint:

findings

type

compared

al.

clinical the

mucosa.

stimulated et

both

cancer,

gastric

and

Furthermore,

study

pathophysiological The

as

in

early

normal

elevated

between

of

of

(Yamagata

mucosa.

cancer

preserved

type

(mean•}s.n.)

function

previous

that

well

endoscopically

contrary,

function

Our

is

ulcerative

(mean•}s.D.)

gastric

secretory

the

mEq/hr

secretory

normal

have

In of

mg/hr

depressed

- gests

stimulation

al.

et al.

benign

paid

to

contained

gastric the

finding

seems

to

diseases

dissociation

in

basal

and

that

the

abs

does

not

be

necessary

such

as

observed stimul ated

rule

out

the

on

the

peptic in

ulcer

secretory f

gastric

juice i

study. et

al.

associated

(1932) with

have the

pointed absence

out of

acid

ence

of

pepsin

secretion

secretion ,

while

pepsin

can

be

Gastric

secreted

without

anacidity

which

accompanying still preserve

elevated

type

of early

supports

the

report

dissociation of gastric

can occur

cancer

Polyp

acid the

in various

Stomach

Cancer

43

secretion

secretion

of the

mentioned

and

. Fig. 2 shows several cases of of pepsin both in benign polyp and in

stomach

. Namely the present study not only above , but also further demonstrates that such gastric diseases which accompany atrophic changes

mucosa.

References

1) 2) 3) 4)

5) 6)

7) 8)

9)

Anson, M.L. & Mirsky, A.E. (1933) The estimation of pepsin with hemoglobin . J. gen. Physiol., 16, 59-63. Bockus, H.S., Bank, J. & Willard, J.H. (1932) Achlorhydria with a review of 210 cases in patients with gastrointestinal complaints. Amer. J. med. Sci., 184, 185-201. Cornet, M.M. A., Renault, P., Carnot, F., Blanc, D., Pelavierre, P. & Terris, G. (1971) Polypes gastrigues. Arch. Fr. Mal. App. Dig., 60, 507-524. Ishimori, A., Kano, A., Sakurada, H., Arakawa, H. & Yamagata, S. (1974) Comparative study on histological changes around ulcer lesion and secretory function between peptic ulcer and ulcerative type of early cancer of the stomach. Gastroenterologia japonica, 9, 35-40. Klein, H.C. & Geller J.S. (1951) Gastric polyp to gastric carcinoma. Gastroenterology, 17, 442-444. Konjetzny, G.E. (1913) Uber die Beziehungen des chronischer Gastritis mit ihren Folgerscheinungen and des chronischen Magenulcus zur Entwicklung des Magenkrebses. Beitr. klin. Chir., 85, 455. Laudano, O.M. & Roncoroni, E.C. (1965) Determination of the dose of Histalog that provokes maximal gastric secretory response. Gastroenterology, 49, 372-374. Sakita, T., Oguro, Y., Takasu, S., Fukutomi, H., Miwa, T. & Yoshimori, M. (1971) Observations on the healing of ulcerations in early gastric cancer. Gastroenterology, 60, 835-844. Yamagata, S., Ishimori, A., Sato, H., Ishihara, K., Masuda, M., Kasugai, T., Yoshitoshi, Y., Takahashi, T. & Wada, T. (1975) Secretory function of the stomach of Japanese with endoscopically normal gastric mucosa. Castroenterologia japonica, 10, 62-167.