The Blood Diastase in Acutely Perforating Peptic Ulcers. ∗

Abstract

Meyer and Antman 1 recently reviewed the meagre literature on the blood and urinary diastase in peptic ulcers. The results were inconclusive. They reported 3 cases of high urinary diastase in patients with peptic ulcers involving the pancreas. One case was proved by autopsy; the other 2 cases were treated medically, the diagnosis being based upon the clinical picture and X-ray examination.

The fact that high diastase is as a rule associated with acute pancreatic disease has led to the idea that the situation of perforating peptic ulcers, especially in relation to the pancreas, might be indicated by the level of the blood diastase. This report is based on a study of 9 cases of acute perforating ulcers, all of whom came to operation or postmortem examination. The situation of'the lesions was verified. The diastase was determined by Somogyi's method. 2

With 80 to 180 as the normal range of diastatic values, 2 it can be seen that in the 4 cases in which the ulcer involved the pancreas the blood diastase was elevated. In 3 of the 4 cases the increase in diastase was moderate; while the fourth was high, coming within the range of the figures usually encountered in acute pancreatitis. Of the 5 cases in which the ulcer was not near the pancreas, 2 showed figures within the normal range, while 3 were definitely subnormal. According to Somogyi, low diastase is frequently associated with impaired liver function. 2 This may indicate some relationship between ulcer and biliary tract-liver disease.

We may tentatively say that a normal or low blood diastase rules out not only acute pancreatitis but a peptic ulcer perforating near the pancreas. A high diastase in a case of sudden sharp pain in the upper abdomen usually indicates pancreatic involvement. A moderate increase during the height of an attack, would tend to indicate a perforating peptic ulcer. A very high diastase, while usually associated with acute pancreatitis, may mean an ulcer acutely perforating in or near the pancreas, as one of our cases proved. This possibility must be taken into consideration in the diagnosis of acute pancreatitis, since the treatment is different.