Surgical Classification of Gastric Ulcers

Johnson described 3 types of gastric ulcers based on location and pathogenesis. A fourth type was reported by Csendes et al.

Location: Ulcers tend to occur at junctions between different mucosal types (oxyntic-antral, antral-pyloric, esophago-gastric).

Location	Acid Production	Type
body of stomach	low to normal	I
body of stomach and duodenum	increased	II
prepyloric or pyloric (within 2 cm of pylorus)	increased	III
subcardial or juxtacardial (within 4 cm of squamocolumnar junction)	low to normal	IV

where:

• Type II or III ulcerations may be treated with vagotomy because of acid hypersecretion.

• Type III ulcers are also referred to as pyloric channel ulcers.

Type	Associations
I	diffuse antral gastritis or multifocal atrophic gastritis
II	perforation or obstruction
III	perforation or obstruction
IV	massive or recurrent bleeding, deep penetrating ulcer without perforation, slow gastric emptying

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