Chronic gastric ulcer

Abstract

Of primary importance in examining patients who give histories of peptic ulcer is to ascertain the situation of the lesion by roentgenologic examination; that is, to learn whether it is in the stomach or duodenum. This should be ascertained in every case in which the condition of the patient permits of it, before prolonged medical treatment is instituted. The necessity of this is to eliminate the possibility that the lesion may be a malignant rather than a benign gastric ulcer; not infrequently in cases of carcinoma the early history is typically that of benign gastric or duodenal ulceration. The treatment of gastric ulcer is dependent on several factors, among which are: (1) the duration and type of symptoms; (2) the healing of the lesion or its failure to heal under a medical regimen carried out in a scientific fashion; (3) the presence or absence of a crater, especially with respect to bleeding; and (4) the presence or absence of pyloric obstruction. When the symptoms have been of short duration and the ulcer is small, every attempt should be made to induce healing of the lesion by non-surgical means. When roentgenologic examination discloses that the ulcer has a demonstrable crater, especially when episodes of bleeding have occurred, when the lesion is producing pyloric obstruction, or when it is prepyloric in situation or is on the greater curvature, generally speaking surgical removal of the lesion should be undertaken without delay. A good working principle is to regard all gastric ulcers as malignant until they are proved to be otherwise. The fact that an ulcer of the stomach is reported by the roentgenologist to be probably benign does not exclude the possibility that the lesion is carcinomatous. The roentgenologist wishes such an opinion of his to be considered only as a contribution to the final diagnosis. The types of operation employed at The Mayo Clinic in the treatment of duodenal ulcer have consisted for the most part of (1) partial gastrectomy of the Billroth 1, or Polya, or Polya-Balfour type if the lesion was large and perforating, and (2) excision or destruction of the ulcer, combined with gastro-enterostomy, if the lesion was small and was proved to be benign on microscopic examination. Infrequently excision of the ulcer and sleeve resection of the stomach have been employed. The results of a properly chosen, properly performed operation for gastric ulcer are some of the best in surgery, and recurrence of the ulcer or disturbing symptoms without formation of ulcer practically never are encountered. This is especially true when the operation performed is partial gastrectomy.