[A clinical study of pathophysiology and treatment of intractable gastric ulcers based on 24-hour intragastric pH monitoring].

The 24-hour intragastric pH monitoring was conducted in patients with gastric ulcers treated with an H2 blocker, and the pathophysiological conditions and the treatment of intractable gastric ulcers were studied from the aspect of degree of intragastric acidity. During the administration of a standard dose of an H2 blocker, there was no difference of intragastric acidity at night between intractable gastric ulcers and tractable gastric ulcers. However, intragastric acidity was significantly higher during the day in the intractable gastric ulcers. The pH 3 holding time rate during the day in all intractable gastric ulcer patients was less than 45%; however, in the tractable gastric ulcer patients it was more than 45% during the day. In treating intractable gastric ulcers, if combined administration of synthetic prostaglandin E2 having a suppressing action of gastric acid secretion was performed or if the drug was changed to a proton pump inhibitor, a rise in intragastric pH was observed and earlier cure was obtained. That is to say, intractable gastric ulcers are characterized by inadequate suppression of gastric acid during the day, and it is surmised that if gastric acid can be adequately suppressed not only during the night but also during the day, no matter which drug or administration method is used, it will be effective against intractable gastric ulcers.