Direct Observations on the Mechanism of Pain in Duodenal Ulcer

Abstract

An extensive literature has developed with respect to the mechanism of pain in gastric and duodenal ulcer. For this reason, in this brief report, we shall make no reference to previous studies but merely describe some observations made during the course of an operation under local anesthesia upon a patient with a duodenal ulcer.

The patient, a well developed white male 37 years of age, first experienced epigastric distress of the ulcer type in 1920. A diet of bland food together with the daily ingestion of powders (presumably alkalies) afforded some relief, but in April, 1922, his distress became so marked that an operation was advised and performed elsewhere. At operation a duodenal ulcer was found and a posterior gastro-enterostomy done. This gave more or less complete relief until 1924, at which time epigastric pain returned more severe than before and persisted intermittently until we first saw the patient in March, 1928. The symptoms and findings at this time were those of a gastro-jejunal ulcer. In April, 1928, the abdomen was opened by one of us (L.R.D.). A jejunal ulcer was found as well as the scar of an old ulcer on the anterior wall of the duodenum about 1 1/2 cm. distal to the pylorus. There was no evident pyloric stenosis. The jejunal ulcer was excised, the gastroenterostomy disconnected, and the openings in the stomach and jejunum closed. Following this operation the patient remained free from distress only until October, 1928, when he returned to the hospital, this time complaining of symptoms similar to those of 1920. The periods of distress bore the time relations to food taking characteristic of duodenal ulcer and the distress itself was completely relieved by food and adequate alkalies.