Gastric acid secretion, parietal cell sensitivity, and endoscopic characteristics of duodenal ulcer patients with and without stigmata of recent bleeding.

Duodenal ulcer patients with stigmata of recent hemorrhage are at high risk of rebleeding. Whether the acid secretory capacity, the parietal cell sensitivity and endoscopic characteristics are different in patients with and without stigmata of recent hemorrhage are unclear. To investigate these, we studied 885 patients with active duodenal ulcer. Among them 693 patients presented with pain only and the rest with gastrointestinal bleeding. Within the latter group, 135 patients had no or minor stigmata (i.e., flat spot) of bleeding while 37 patients had major stigmata of bleeding (i.e., visible vessel and visible clot). The basal acid output and gastric acid output in response to infusion of graded doses of pentagastrin from 93.8 to maximal dose of 6000 ng/kg.hour (maximal acid output) were measured. The dose of pentagastrin required for half maximal response to gastric acid output was taken to represent the sensitivity of the parietal cells to pentagastrin (D50c). The results demonstrated that the basal acid output, maximal acid output, and D50c were not significantly different among the three groups. Endoscopically the size and site of the ulcer were similar, but patients with major stigmata of bleeding had significantly higher degrees of duodenal inflammation and deformity. We conclude that gastric acid secretion and D50c were not significantly different in patients with major and minor stigmata of recent bleeding, indicating that gastric acid may not play a significant role in precipitating gastrointestinal bleeding.