Basal and pentagastrin stimulated acid output was measured in 80 normal and 179 duodenal ulcer subjects of Chinese, Indian and Malay origin. Basal and maximally stimulated acid output was significantly higher in duodenal ulcer patients compared with normal subjects. There was however considerable overlap and less than one in four duodenal ulcer patients were hypersecretors. The acid output (and hence the parietal cell mass) was lower than in Caucasian subjects and this was possibly related to weight differences. The acid output did not differ significantly in the Chinese, Indian and Malay subjects, suggesting that parietal cell mass in the three racial groups is closely similar. The difference in frequency of duodenal ulcer disease in the three racial groups is thus not related to gastric secretory capacity.
Paired augmented histamine tests using 40 microgram 60 microgram histamine acid phosphate (HAP) per kg body weight were conducted on each of 57 Asian subjects. The mean peak acid output (PAO) for the total series to the two different doses of HAP was 22.3 mEq/hr and 23.3 mEq/hr respectively and the difference was not statistically significant according to the paired t test. There were similarly no significant difference in PAO to the two doses of HAP in the following groups of subjects: 26 Chinese, 17 Indians, 14 Malays; 24 subjects with duodenal ulcer, 16 controls; 28 subjects with body weight below 50 kg, 19 between 50-60 kg and 10 exceeding 60 kg. These findings differ from earlier reports that for maximal gastric secretion Asians required a higher dosage of histamine compared with Caucasian subjects.
A 10-year experience in the diagnosis and treatment of 92 patients with inflammatory bowel diseases in Kuala Lumpur is described. Tuberculosis (34 cases) was the most common inflammatory bowel disease of surgical importance. The clinical presentation of tuberculous enteritis and Crohn's disease is similar, though tuberculosis is strongly suggested by associated pulmonary disease and radiological evidence of caecal involvement. The finding of 10 cases each of Crohn's disease and ulcerative colitis is in keeping with an increased awareness of these conditions in a developing urban society where facilities exist for thorough investigation of diarrhoeal diseases. Amoebiasis sometimes causes a granulomatous lesion simulating carcinoma. Diverticular disease of the colon as known in the West is of very rare occurrence.
This is a review of 261 patients operated for 271 instances of mechanical intestinal obstruction over a 5-year period in a developing country in the tropics. The pattern of intestinal obstruction in Chinese is similar to that in Caucasians, where adhesions account for the largest number of cases. The occurrence in Malays, Indians, Pakistanis and Ceylonese is similar to that in other developing communities where external hernia is commonest while adhesive or tumour obstruction is rare; however, these racial groups do not exhibit the high incidence of intussusception and volvulus found in Africa and India. The operative mortality was 13-9 per cent, which is comparable to that in Western series. The major adverse factors in intestinal obstruction, i.e. extremes of age, associated disease, gangrenous bowel, large bowel obstruction and malignancy, were confirmed. Fluid and electrolyte imbalance was frequent, as in other tropical series, but with intensive preoperative correction it was not an important adverse factor.
The clinical features and pathology of 17 patients with gastrointestinal lymphoma are reviewed. The small intestine was the site most commonly involved. Emergency presentation was usual: 11 of the 17 patients presented as acute abdomen or gastrointestinal haemorrhage. The frequency of gastrointestinal lymphoma to carcinoma in the Chinese and Indians was comparable to that in the West but a higher frequency was found in the Malays and Orang
Asli.