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Chapter 5 (page 22)
Using macroscopic techniques in 53 fresh, non-diseased post-mortem specimens,
Landboe-Christensen (l944) found that the border between pyloric and duodenal mucosa
might lie either on the perpendicular, duodenal side of the pyloric ring, at the top of the
ring, or on the sloping gastric side of the ring. With ageing there was a tendency for the
border to shift from the duodenal to the gastric side of the ring.
Using microscopic methods in 110 cases of partial gastrectomy for duodenal ulcer, Oi
and Sakurai (l959) came to essentially similar conclusions. In all specimens the border
was within 5.0 mm of the summit of the pyloric "sphincter muscle" (presumably the
pyloric ring), either on the duodenal or on the gastric side. The pyloric mucosa was in
direct contact with the duodenal mucosa, i.e. the border could be identified as a line, in
contrast to the border between pyloric and oxyntic mucosa, which consisted of a
transitional zone of varying width.
Landboe-Christensen (l944) studied the extent of the pyloric mucosal zone on the oral
side by macroscopic tehcniques in 47 non-diseased, fresh post-mortem specimens. In all
instances this zone was longer on the lesser than on the greater curvature, covering on
average 7.2 cm of the lesser, and 5.2 cm of the greater curvature. The average percentage
of the lesser curvature covered was 44 percent, and the average percentage of the greater
curvature covered was 12 percent. The border between pyloric and oxyntic mucosa was
irregular, often dentate or tortuous, and as a rule a number of islets of oxyntic mucosa
were encountered in the pyloric zone. There was a transitional area of varying width
between the two zones. In practice, a line drawn from the junction of the upper three-
fifths and lower two-fifths of the lesser curvature, running downwards and to the right,
indicates the approximate boundary of pyloric mucosa (Fig. 5.1).
Dean and Mason (l964) studied 117 fresh gastric resection specimens microscopically
(resected for either duodenal or gastric ulcer). In l8 cases of duodenal ulcer the average
length of pyloric mucosa along the lesser curvature was 9.0cm, and along the greater
curvature 7.4 cm. On an average the pyloric mucosa extended for l.5cm further up the
lesser than the greater curvature. In the majority of all duodenal ulcer specimens the
transitional zone between pyloric and oxyntic mucosa varied from 0.5 to 5.0 cm in width,
the average width being 1.0cm. The upper limit of the pyloric mucosa showed wide
individual variations. Patients with gastric ulcers tended to have a greater extent of
pyloric mucosa than those with duodenal ulcers, and women with gastric ulcers had more
pyloric mucosa than men with gastric ulcers.
Relationship between pyloric sphincteric cylinder and pyloric mucosal zone in
normal stomach. Arrows, contracted sphincteric cylinder; broken line,
approximate border between pyloric and oxyntic mucosal zones.
Schrager et al. (l967) studied the "antrum" microscopically in 45 normal stomachs
obtained at necropsy, in 75 resection specimens of duodenal ulcer and in 40 specimens of
gastric ulcer. Normal stomachs showing clear histology were not easily obtained due to
the speed with which autolysis occurs after death; in only 13 could measurements be
made. Normally the average length of pyloric mucosa between the "sphincter" (i.e. the
pyloric ring) and the boundary zone on the lesser curvature was 8.9 cm, with an average
"sphincter" to cardia distance of 22.5 cm. Thus the pyloric zone encompassed 40 percent
of the lesser curvature. On the greater curvature the average figures were 4.8 cm, 39 cm
and 12 percent respectively. Comparative studies showed that in the majority of
duodenal ulcer patients the pyloric zone was larger than in normal controls, and in the
majority of gastric ulcer cases it was almost twice the normal size.
In surgical pH monitoring tests, Capper et al. (l962, l966) found a wide variation in size
between the small pyloric zone of duodenal ulcer and the larger zone of gastric ulcer
cases. With duodenal ulceration the zone was usually of normal size or smaller,
extending to a line 3.0 to 4.0 cm from the pylorus. (In their only normal subject, the
pyloric zone was 4.0 to 5.0 cm in length.) In gastric ulcer cases the pyloric zone was
very much larger, at times encompassing the whole of the lesser curvature. Capper et al.
concluded that the junction between the distal alkaline, pyloric zone and the proximal
oxyntic zone was not static, but that it might migrate up and down the stomach. The
alkaline zone could have been a normal "antrum", but it could also have represented
oxyntic mucosa which had been altered by gastritis.
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