Clinical Evaluation for Acute Gastric Mucosal Lesion

Chikara Kunisaki, Mitsugi Sugiyama*, Toshiro Yamamoto, Hiroshi Katamura, Shigeyoshi Ito, Masafumi Kin, Yoshiki Sato

Second Department of Surgery, Critical Care and Emergency Medicine*, Yokohama City University School of Medicine

A clinical evaluation of 72 patients with acute gastric mucosal lesion (AGML) seen at the Second Department of Surgery and the Department of Critical Care and Emergency Medicine from August 1979 to December 1991 was performed to establish prophylactic treatment and therapy. Clinical variables such as etiology, diagnosis, therapy and prognosis were analyzed statistically, dividing the cases into two time periods, the first 6 years and the last 6 years. Fifty-six patients (38 had undergone surgery, 18 had not) were included in the first time period and 16 (7 had undergone surgery, 9 had not) in the second. Mortality during the first time period was 43.1%; this decreased dramatically to 14.3% in the second time period. In both periods, AGML was likely to occur in complicated cases such as those with obstructive jaundice, renal failure or cerebrovascular disease in which the gastric mucosal blood flow decreased. In addition to improved management of patients pre- and postoperatively, the widespread acceptance and use of H₂-receptor antagonists such as cimetidine has led to a gradual decrease in AGML, and the number of operations and the mortality rate have decreased dramatically. From these results, it was concluded that H₂-receptor antagonists or agents such as teprenone that increase defensive factors have clinical effectivenes as prophylaxis and therapy for AGML.

Key words
acute gastric mucosal lesion, H₂-receptor antagonist, surgical stress, obstructive jaundice

Reprint requests
Chikara Kunisaki Department of Surgery, Fujisawa City Hospital
2-6-1 Fujisawa, Fujisawa City, 251 JAPAN

Accepted
July 6, 1992

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