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Endoscopic confirmation of the complete healing of gastric ulcer with special reference to its pathophysiological background



Endoscopic confirmation of the complete healing of gastric ulcer with special reference to its pathophysiological background



Stomach & Intestine (Tokyo) 19(9): 1001-1010



Sakita et al. have reported a useful classification of the 3 stages of gastric ulcer based on endoscopic findings: i.e., active stage (A1-A2), healing stage (H1-H2) and scarring stage (S1-S2). The need for a clearer understanding of the correlation of gastric ulcer healing process by endoscopy, dissecting microscopy, scanning or transmission electron microscopy and histology was expressed. Four stages of gastric ulcer can be classified by dissecting microscopy: initial stage, growing stage, palisade scar stage and cobblestone scar stage. The palisade scar stage corresponds to Sakita's S1 (red-scar) stage and is an immature phase of a differentiating process as compared with the cobblestone scar stage (Sakita's S2-white scar) from the EM ahd histochemical findings. In 8 patients with gastric ulcer scar, the effect of secretin on gastric mucosal blood flow was investigated, using an endoscopic H2 clearance method. There was a significant increase (49.8%) in blood flow in the scarred area, which revealed a higher increasing rate in the S1 stage than in the S2 stage. The recurrence rate of gastric ulcer closely correlates with the endoscopic scarring stage present at the time of withdrawal of drug therapy. The prevention of gastric ulcer recurrence using sucralfate showed a high recurrence rate was obtained in patients with red-scar healing as compared with white-scar healing suggesting that complete healing of gastric ulcer should be assessed after endoscopic confirmation of Sakita's S2 stage from the morphological and functional standpoint of regenerated epithelium.

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