A roentgenological study on the position of the stomach in Korean adults, and the radiological evaluation ofgastric acid secretion

Lee, M J

Abstract

The position and form of the stomach vary depending upon the position and habit of the body, spatial conditions of the abdominal cavity, phase of respiration, level of the liver and diaphragm. There has been muchspeculation about the criteria and significance of gastroptosis. Some regard gastroptosis as a manifestation of asthenic habit, while others claim that this entity is a generalized symptom comlex. However, it appears that manyclinicians in this country prefer to ascribe the gastric symptoms subtly to gastroptosis in the patients in whomno organic lesions can be detectable on x-ray study and physical examination of the gastrointestinal tract. Furthermore, they way that level of the stomach is considerably lower in position and the incidence of gastroptosis is much higher in Koreans than in western peoples of in Japanes. Employing a roentgenological study the author made observations on the level and form of the stomach in 100 healthy Korean adults and on the interrelationships of the stomach, level of the other abdominal viscera and gastric emptying time in 46 symptomatic patients with no demonstrable organic lesions. The interrelationship betwen the acidity of gastricsecretion and the mucosal pattern of the stomach and duodenum was also evaluated in 92 patients in whom nodemonstrable organic lesion was found. The results obtained are summarized as follows; 1. The lower pole of the stomach was lying below Jacob's line in 18% of 73 healthy men under 40 years of age and in 44% of the asymptomatic individuals over 40 years, while in symptomatic group it was lying below Jacob's line in 35% of 65 men under 40 years of age and in 56% of 71 patients over 40 years. 2. The incisura angularis of the stomach was observed lyingbelow Jacob's line in 7.5% of the symptomatic group. On the contrary, the incisura angularis was located above thelevel of the iliac crest in all of the healthy group. 3. The stomach of Korean adualts was slightly higher inposition than in Americans and Japanese as compared with the data obtained from these foreigners. Even in the symptomatic patients, the incidence of so called gastroptosis was shown to be lower than in these foreign peoples.4. The gastric emptying time tended to be more prolonged when the stomach was lying in lower position. 5. Thelevel of other abdominal viscera closely correlated with that of the stomach. Gastroptosis may be regarded as amanifestation of vesceroptosis. 6. It is felt justifiable that the idea of regarding the lower pole of the stomachlying below Jacob's line as gastroptosis should be abandoned, and that the term of gastroptosis should bepreserved only for the cases in which the incisura angularis lies well below the level of the iliac crest. 7. There was a fair correlation between the acidity of basal gastric secretion and rugorsity of the gastric and duodenal mucosal folds. Rugal atrophy was consistent with low acidity, and the coarser the mucosal folds, the higher was gastric acidity. Judging from the appearance of the mucosal pattern of the duodenum and stomach, achlorhydria and high gastric acidity can easily be estimated in the majority of cases.