Intermediate zone and gastric ulcer. A study on autopsy cases of the aged

The relationship between intermediate zone and peptic gastric ulcer was histopathologically studied on stomachs obtained from autopsy cases of aged people. They composed of: 58 cases of gastric ulcer (UI-IV), among which 18 cases were open ulcers (average age, 73 yr old) and 40, scarring ulcers (average age, 78 yr old); and 128 control cases, which were composed of 8 groups, each group composed of 16 cases randomly selected from the 70th, 80th, 90th and 100th decade of males and females, respectively. In this study, the upper border of the intermediate zone was defined as the most oral point where fundic glands became continuous, and the lower border was defined as the most oral point where nest-like group of fundic glands started to appear. In the control cases without circumscribed lesions, there was an age-related increase in frequency of intestinal metaplasia and atrophy of fundic glands. However, this increase was much less than that expected from the observation on materials obtained at operation, as well as biopsy. The upper border of intermediate zone did not move upwards in association with age, and the lower border changed greatly by the individual, giving no apparent age-related changes of the borders. Peptic gastric ulcers, including healed ones, were always observed within the intermediate zone. In high-located ulcers, the intermediate zones were also high-located, while in low-located ones, the intermediate zones were observed still in the lower area of the stomach. Considering the above-mentioned findings, age-related movement of the intermediate zone was different individually although there was a trend of slight upward movement in association with age, and therefore the position of peptic ulcer (UI-IV) in the stomach was different individually, and there was no apparent age-related upward movement of it. Moreover, there was no definite relationship between the age of the individual and the size of the ulcer. It could be concluded that there was no gastric ulcer which was characteristic of aged people. As an additional finding, in the cardiac region, isolated foci of intestinal metaplasia were present in 18% of the control group, and 45% in the ulcer groups. This may indicate the fact that there is another process of intestinal metaplasia beginning from the cardiac region.