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韓國人에 있어서 慢性胃炎에 關한 硏究

A HISTOLOGICAL STUDY OF CHRONIC GASTRITIS IN KOREA

대한의학협회지 1968년 11권 5호 p.403 ~ 425
鄭克守, 洪錫宰,
소속 상세정보
鄭克守 (  ) - 慶北大學校 醫科大學 內科學敎室
洪錫宰 (  ) - 慶北大學校 醫科大學 病理學敎室

Abstract


It has been believed that there might be a high incidence of chronic gastritis in Korea because of its highly irritative dietary habits, but so far systemic histological and clinical studies in this country have been almost null. In a series of studies upon chronic gastritis, we attempted to see the incidence of chronic gastritis, its relationships with various dietary habits and other clinical aspects as well as the relation-ships between chronic gastritis and peptic ulcer or gastric carcinoma in Korean. The materials consisted of total 272 biopsied cases (using Wood type suction biopsy tube), 153 surgically resected stomachs with peptic ulcers or gastric carcinomas and 62 autopsied cases including 12 fetal stomachs.
The biopsy cases included 29 healthy young soldiers with negative upper G.I. series who had no ´complaints whatsoever concerning digestive or other organs and 153 young soldiers and 90 civilian of various age groups with upper G. I. negative dyspepsia. The autopsy cases included 50 cases who had no digestive symptoms in reports and without gross evidence of stomach diseases (peptic ulcer or carcinoma. etc.) in specimens and 12 fetal stomachs. The above materials were for the study of primary chronic gastritis. The surgically resected stomachs included those of 21 duodenal ulcers, 60 gastric ulcers and 74 gastric carcinomas. These were for the study of accompanying chronic gastritis.
The results of the study were summarized as follows:
1) The incidences of chronic superficial, borderline and atrophic gastritis in young healthy soldiers were 41.4, 6.9 and 3.5% respectively and those in young soldiers with upper G. I. negative dyspepsia were 39. 9, 4.6 and 4.6% respectively.
2) In civilian of various age groups, the incidences of superficial, borderline and atrophic gastritis were 40. 0, 1.1 and 18.9% respectively, while those of autopsied stomachs of over 10 years of age were 34. 3, 14.3 and 17.1% respectively. The incidence of atrophic gastritis in adults, accordingly, seemed to be around or less than 20% in Korea.
3) The incidence of primary atrophic gastritis increased with the age.
4) The most frequent chief complaint in upper G. I. negative dyspepsia was epigastric pain of various degrees and characters, the incidence being around 70% both in young soldiers and civilian groups.
5) The chief complaints or symptoms both in young soldiers and civilian groups were much similar in their character and frequency regardless of the histology, normal or abnormal,
6) The results 1 and 5 shown above seem to suggest that the chief complaints or symptoms presented by the patients might not necessarily be due to the gastritis but the larger part of them would well be caused by other mechanisms, for example, psychoneurologic mechanism.
7) As for the etiologic factors, the hot pepper, hot drinks, the size of meals, alcohol and tobacco did not seem to haveany intimate relationships to the mucosal pathology.
8) The results 2 and 7 shown above and the fact of definitely higher incidence of chronic gastritis especially of atrophic from in Japanese whose dietary habits are believed much less irritative than in Korean suggest that the traditional irritative dietary habits in Korean appeared not to increase the incidence of chronic gastritis.
9) Follow up biopsy studies done on a part of the cases showed that the histologic findings in larger part of the cases remains unchanged, while the subjective symptoms usually improved during the period of follow up observation (1 month to 1½ years).
10) In surgically resected stomachs for peptic ulcers or carcinomas, chronic gastritis were seen in all of them.
11) The chronic gastritis in resected stomachs was most severe in pyloric antrum and most mild in greater curvature of the body.
12) In duodenal ulcers, the chronic gastritis was milder in general, while in gastric ulcers and carcinomas the gastritis was severe in many of the cases.
13) The atrophic gastritis in pyloric antrum, lesser curvature and greater curvature had the incidence of 38.1, 23.8 and 4.8% respectively in duodenal ulcer, 51.7, 41.7 and 30.0% respectively in gastric ulcer and 68.5, 50.7 and 41.7% respectively in gastric carcinoma.
14) The distritbution of atrophic gastritis according to the distance from the gastric lesion (ulcer or carcinoma) (nearby the lesion and 1 inch each apart: from it in anterior wall-posterior wall-lesser curvature- and greater curvature-directions) showed that in gastric ulcer the incidence of atrophic gastritis (58.3~65.8% nearby the lesion) became lower in distant portions (39.4~53.1%in areas of 1 inch apart and 10.0~38.9% in areas of 2 inches apart) except for the pyloric antrum where atrophic gastritis was fairly diffuse (57.1~61.1% in incidence). In gastric carcinoma, however, it had a tendency of diffuse distribution and there was no distinct tendency to decrease according to the distance from the lesion as in gastric ulcer, both in antrum and body of the stomach (40.9~68.0% in incidence as a whole).
15) Atrophic gastritis was diffuse in 15.8% of gastric ulcers, 41.9% of gastric carcinomas, diffuse or patchy in 79.0% of gastric ulcers, 85.4% of gastric carcinomas and was absent nearby the gastric lesions in 34.4% of gastric ulcers and 19. 4% of gascarcinomas. The later datum suggests that not all of the gastric carcinoma arises in atrophic gastritis.
16) Intestinal metaplasia of gastric mucosa was not seen in normal histology but seen exclusively in chronic gastritis. Its incidence and extent were most marked in atrophic gastritis.
17) The distribution of intestinal metaplasia according to the sites of the stomach, gastric diseases (ulcer or carcinoma), distance from the gastric lesions and age groups was in parallel with that of atrophic gastritis.
18) The highest incidence of intestinal metaplasia was in gastric carcinoma, lowest in duodenal ulcer and intermediary in gastric ulcer (93.2, 42.9 and 68.3% respectively). The incidence ofintestinal metaplasia in primary chronic atrophic gastritis was 57.9%.

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