The preponderance of the investigation dealing with the pathogenesis and the maintenance of chronic duodenal ulcer has been concerned with the acid gastric juice. A large amount of work has been reported tending to incriminate this factor and designed to determine the best means of combating and alleviating its ill effects. As a consequence, clinical attention has been narrowly focused on the acidity in the stomach, while the acidity in the duodenum has been almost entirely neglected. In order to evaluate adequately the role of the acid gastric juice in duodenal ulcer, it is essential to know what effect the acid chyme has on the reaction and the neutralizing ability at the actual site of the ulcer—the duodenal bulb.
The contents of the first part of the duodenum in normal persons have been shown to possess an ability to neutralize, buffer and dilute gastric chyme which is generally very efficient.