Location of peptic ulcers in relation to antral and fundal gastritis by chromoendoscopic follow-up examinations

The extent of fundal gastritis and the severity of antral gastritis in patients with duodenal ulcer and coexisting gastroduodenal ulcers were investigated using the endoscopic Congo red test. Forty-two patients with duodenal ulcer were followed-up by chromoendoscopy to investigate the location of gastric ulcers developed during the average observation period of 3.6 years in relation to the changes of fundal and antral gastritis. Duodenal ulcers were usually associated with extensive acid-secreting areas and moderate antral gastritis. In coexisting duodenal and antral ulcers, antral gastritis was usually severe, although fundal gastritis was of the same intensity as that seen with duodenal ulcers. In coexisting duodenal and high-lying ulcers, fundal gastritis was extensive and antral gastritis was severe. Follow-up studies showed that there was a significant relationship between the development of gastric ulcer and the changes of antral and fundal gastritis. Gastric ulcers developed in the antrum or the angulus in patients with duodenal ulcer when antral gastritis became worse, but no fundal gastritis spread. When fundal gastritis spread, ulcers developed in the gastric body. These findings suggested that development of increasing gastritis predicted the development of gastric ulceration and that the locations of gastric ulcer and duodenal ulcer were determined by the extent of fundal gastritis and the severity of antral gastritis.