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technique. Nevertheless, the afore-mentioned acridine orange method can provide be t t e r informations on the process.

(5) DIFFERENCE BETWEEN GASTRIC ULCER AND DUODENAL ULCER

Haruya Okabe, M.D. 2nd Department of Internal Medicine, Kyushu Univ. (Director Prof. S. Katsuki)

Introduction I t has been well known tha t there are many differences between gas t r ic and duodenal ulcers; i.e. the earlier average age period of the patients with duodenal ulcers, the greater incidence of duodenal ulcer in the male with the more even distribution in the two sexes of gastr ic ulcer, the very clear differences in the pat tern of gasric secretion produced by these two different ulcers and so on.

Because of these differences, there have deen two opposing opinions concerning wheter these two ulcers are essentially same or different. Shay and Sun believe tha t the changes of gastr ic moti l i ty and gastr ic secretion actual ly represent effects produced by the two lesions in their respective areas ra ther than differences in the fundamental mechanisms responsible for their production.

On the other hand, Dragstedt developed his opinion tha t duodenal ulcers are usually due to hypersecret ion of gastr ic juice of nervous origin and tha t gastr ic ulcers are usually due to a hypersecret ion of gastr ic juice of humoral origin. McConnell emphasized that the gastr ic and duodenal ulcer must be considered seperate ly because fo convincing evidence that they are inherited independently.

I t has to be said tha t the question whether gastr ic ulcer and duodenal ulcer are essentially the same disease located in different anatomic areas or whether they are different diseases has not been settled.

We have re-examined deliberately X-ray films of the upper G. I- tract and gas t rocamera films of the consecutive 10,000 ambulant pat ients who visited a Diagnostic Center of Stomach Diseases during more than 4 years f rom Dec. 1964 to Feb. 1969.

Materials and methods: Eleven hundred ninety-two cases with gastr ic ulcer alone, 659 cases with duodenal ulcer alone, and 236 cases with combined ulcers were extracted f rom the 10,000 paients. The all pat ients were divided into 7 age- groups ranging f rom second to 8th decades. Comparison of the frequencies of the gastric, duodenal and combined ulcers on each decades were performed. Gastric secretory pa t te rns and blood types were compared with each other among these 3 groups with different ulcers.

Results 1. Among the 7 age-groups consisting of the 10,000 consecutive patients, the group of the 4th age-decade is the numerous. The more far the age- group f rom this peak decade, the less in numbers of the pat ients in both sides.

2. The number of the patients with gastr ic ulcer are the most numerous in the 6th decade, tha t with duodenal ulcer in the 4th, and tha t with combined ulcer in 5th.

3. The pa t te rns of the frequencies in percent of gastric, duodenal and combined ulcers in each decades f rom the second to the 8th are quite character is t ic in these 3 groups. The frequency of the gastr ic ulcer increases s teady following age advances until the peak in 7th decade, while that of the duodenal ulcer decreases f rom the peak in 3rd decade steady. T h a t of combined ulcer also increases in

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order of age more rapidly than tha t of gastr ic ulcer until 5th decade in peak. 4. The pa t te rn of frequencies of the all duodenal ulcer including the combined

ulcers in each decades reveals tha t the highest f requency covers over 3 decades ranging f rom 3rd to 5th in quite same percent, and then decreases slowly in order of age.

From the resul ts above described, the following hypothesis are thinkable: 1) The new occurence of duodenal ulcer m a y finish by 5th decade and be quite few or not af ter tha t age.

2) The ra te of the duodenal ulcer combined with gastr ic ulcer to the all duodenal ulcer increases as the age advances, then the ra te of the duodenal ulcer alone decreases. 3) In the combined ulcer, therefore, the duodenal ulcer usually antedates to the gastr ic ulcer.

To prove these hypothesis, we need to make more detailed s tudy in further. 5. The observed rates of the combined ulcer in each decades are significantly

higher than the expected ra tes in most decades. This means tha t a certain fac tor yet unknown accelerates the occurence of combined ulcer. If the hypothesis above mentioned is r ight, the antedated duodenal ulcer might be this accelerating factor.

6. The results of the gastric secretory pa t te rn following histamine meal are quite different between gastr ic and duodenal ulcer groups. T h a t of combined ulcer is in-between but nearer to tha t of the duodenal ulcer.

7. In comparison of the blood types among these 3 groups, type 0 is much in duodenal ulcer group than in gastr ic ulcer group, which is significant.

Conclusion From the results above described, I feel inclined to separate the gastr ic ulcer f rom the duodenal ulcer as different entity. Also, I think that the gastr ic ulcer combined to the duodenal ulcer will be not quite same with the gastr ic ulcer alone in their etiology, if any at all.

(6) SPECIAL COMMENT TO " COMPARISON BETWEEN GASTRIC AND DUODENAL ULCERS"

T. Sakai, M.D. Department of Surgery, University of Niigata, School of Medicine, Niigata

There might be several points of view concerning the comparison between the gastr ic and duodenal ulcer groups, such as differences in pathogenesis or clinical manifestat ions since the ulcers have once been established as an illness. My particular emphasis at the present discussion will be however concentrated in the following factors, namely, 1) blood type, 2) urinary uropepsin level, 3) dynamic human constitution, and 4) mode of gastr ic acid secretion.

As to the blood type, the results were obtained on the basis of x 2 method on the difference between the actual figures of the pat ients with gastr ic and duodenal ulcers and expectant figures calculated f rom the control distribution of the blood types in the district of Niigata prefacture. The result of this s tudy indicates tha t the gastr ic ulcers f requent ly occur in the pat ients with O and B types, and the duodenal ulcers in those with O and AB types. The ulcers of either group are however less f requent ly encountered in the patients with A type.

The ur inary uropepsin levels in both gastr ic and duodenal ulcer groups are well over the average level of the control group, and the part icular emphasis should be made tha t those in the lat ter group are in all cases present far in excess of the upper limit of the normal value.