Gastric pepsin and acid secretion in patients with acute and healed duodenal ulcer.

The relationship between gastric pepsin, acid secretion, and duodenal ulcer activity was studied in 33 patients with an endoscopically proven carter, in 17 patients who were studied within 3 mo of an acute crater but who no longer had a crater endoscopically, and in 10 patients who had no duodenal ulcer symptoms for longer than 3 mo after a crater and who had negative endoscopy. There were an additional 11 patients who had paired studies in the early-healed and late-healed stages of their disease. There were no significant differences between the values obtained in the paired and nonpaired group. Basal and pentagastrin-stimulated outputs of both pepsin and acid were significantly higher (p less than 0.001) when an acute crater was present than in 23 control subjects. At 3 mo or more after healing there was a significant (p less than 0.001) fall in both basal and stimulated pepsin and acid output which became insignificantly different from that of controls. In 104 basal studies the ratio of pepsin to acid secretion was 33,000 +/- 2500 (mean +/- SE) pepsin units/mmol H+ with no difference between any groups including controls. In 102 stimulated studies the ratio was 13,600 +/- 400 PU/mmol H+, also with no differences between any groups. Although data in the literature are conflicting, these results support a direct relationship between the activity of duodenal ulcer disease and acid-pepsin secretion.