An internist views the surgical treatment of peptic ulcer.

Abstract

The purpose of this paper is to discuss briefly the physiological and pathological basis for the surgical treatment of peptic ulcer and to attempt an appraisal of the results obtained. There are numerous differences between gastric ulcer and duodenal and jejunal ulcer. One of the most important of these is the fact that in gastric ulcer the problem of excluding or differentiating ulcerating carcinoma is always present, whereas in duodenal and jejunal ulcer the probability of carcinoma is so remote as scarcely to warrant consideration. Hence, if the internist is unable to obtain satisfactory evidence that the gastric lesion is benign, operation is indicated. The surgeon at the operating table may have fully as much difficulty in deciding whether the ulcer is benign or malignant as the internist had preoperatively. Consequently, removal of the ulcer, usually by means of subtotal gastrectomy, is almost mandatory. A further difference between gastric and