This study was designed to examine two premises: that the
morphological "severity" of duodenal ulcers (DU) may
influence the incidence of drug mediated healing and the
morphological "quality" of healing after curative therapy
may influence t he duration of remission.
Biopsies taken at endoscopy from five healthy volunteers
and from 84 patients suffering from DU were examined by
light and electron microscopy. The endoscopic and
morphological appearance of the mucosa within 8mm of the DU
or scar, before and up to 1 year after therapy with either
sucralfate, cimetidine, pirenzipine or misoprostol are
described. Irrespective of the mode of therapy or whether
the biopsies were from normal, juxta-DU or scar mucosa,
specimens could be divided into 2 primary morphological
classes: gastric metaplastic and non-metaplastic. Based on
the degree of metaplastic differentiation and nonmetaplastic
degeneration, these classes were further
divided into 4 sub-classes. When correlated with the
incidence of healing and duration of remission, metaplasia
was generally found to be a positive and degenerative nonmetaplasia
a negative prognostic criterion. Scores were
awarded to primary morphological criteria and weighted to
give high total s to favourable (metaplastic) and low totals
to non-favourable (degenerative non-metaplastic) prognostic
features. The sum of scores expressed as a percentage was
termed the morphological index. This proved useful as a
means of correlating mucosal morphology with DU healing and
duration of remission. It also facilitated comparison of
morphology within and between groups of patients before and
after each drug regimen. The results showed that the
morphological appearance of the ulcerative mucosa influenced
healing and remission outcome.
Discriminant analysis was applied to the numeric data that
described the juxta-DU (group 1) and scar (group 2)
morphology of patients treated with cimetidine in 2 studies.
Separation between healed and not healed DU was achieved in
92% of group 1 and 100% (remission - more or less than 6
months) of group 2. When applied to the juxta-DU data from
patients treated with cimetidine in a third study, the
formulae predicted correctly in 88% of cases. In addition to
predicting outcome, the formulae were used as standards to
accommodate for natural variations in the prognosis of
individual DU of patients enrolled for comparative drug
studies. These data show that morphological analysis may be
usefully employed in duodenal ulcer therapy. / Thesis (Ph.D.)-University of Natal, Durban, 1994.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:ukzn/oai:http://researchspace.ukzn.ac.za:10413/8152 |
| Date | January 1994 |
| Creators | Gregory, Michael Alfred. |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
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