Peptic ulcer disease — the transitional zones are important

Abstract

In 1924 Konjetzny declared that `an ulcer does not develop in a healthy mucosa'1. Over the next two decades it became increasingly apparent that peptic ulcers were complications of pre-existing chronic inflammation in the gastric and proximal duodenal mucosa. Indeed it emerged that different patterns of gastritis were associated with gastric and duodenal ulcers; the former was found in stomachs with diffuse chronic gastritis with multifocal atrophy whereas duodenal ulcers were associated with a non-atrophic antralpredominant gastritis in which the corpus showed little inflammation2,3. In the 1950s Oi and his colleagues in Tokyo examined large numbers of gastric resections for ulcer disease and made a meticulous study of the location of gastric and duodenal ulcers in relation to the border zones between adjacent mucosal types4,5. The relationship of peptic ulcers to these junctional zones has been a neglected topic which needs re-examination in the light of Helicobacter pylori ecology.