The Syndrome of Gastroduodenal Disease Associated with Chronic Cor Pulmonale

1. The syndrome of gastroduodenal disease associated with pulmonary emphysema and chronic cor pulmonale is described. Of 65 cases of pulmonary emphysema with right heart disease on whom postmortem examinations were performed, 21 revealed peptic ulcer of the stomach and duodenum, and six showed hypertrophic gastritis. A like number of clinical cases studied with x-rays of the upper gastrointestinal tract yielded a 30 per cent ratio of peptic ulcers and a high incidence of gastritis. Almost all of these cases, with a few exceptions, did not have the history or pain typical of peptic ulcer. A high proportion of these cases died from hemorrhage and perforation. 2. In the absence of characteristic symptoms, lack of polycythemia in a state of marked hypoxia might occasionally serve as a diagnostic pointer for peptic ulcer or bleeding gastritis. Absence of polycythemia, however, may also be due to other causes. In addition, many of these cases do not bleed and maintain the polycythemia. 3. It is advised that all patients of this group be subjected to x-ray studies, and if necessary gastroscopic examinations of the gastroduodenal tract. This is the only means of establishing a proper diagnosis and instituting early treatment in order to forestall serious complications.