CLINICAL-ASSESSMENT OF QUALITY OF ULCER HEALING - A NEW ENDOSCOPIC APPROACH

Aim: To show whether the quality of ulcer healing can be evaluated by endoscopy and whether it affects future recurrence of the ulcer and to determine whether the initial therapy that is selected affects the quality of ulcer healing in patients with gastric ulcers. Methods: Dye-contrast endoscopy, histology and measurement of prostaglandin (PG)E2 synthesis were used to assess the quality of ulcer healing. Results: The rate of ulcer recurrence was significantly higher for ulcer scars which showed a nodular regenerated mucosal pattern on dye-contrast endoscopy, compared with healed ulcers that showed a flat pattern. A regenerated-gland index and the level of PGE2 synthesis were significantly lower in the nodular regenerated mucosa than the flat regenerated mucosa. The combination of a gastroprotective drug with an H-2-receptor antagonist during initial therapy significantly increased the prevalence of ulcer scar area showing the flat pattern of regenerated mucosa compared with an H-2-receptor antagonist alone. Conclusion: These results suggest that an evaluation of the regenerated mucosal pattern of gastric ulcer scars by dye-contrast endoscopy can detect the level of histological and functional maturity of the scarred tissue, and therefore determine the quality of ulcer healing. This study also indicates that the quality of ulcer healing may affect the future recurrence of ulcers and that initial therapy with gastroprotective drugs may improve the quality of ulcer healing, at least for gastric ulcers.