Intractable peptic ulcers—Are they a surgical or a medical problem?

Abstract

1. 1. Peptic ulcer symptoms may occur without demonstrable ulceration or may persist after healing of ulcer. 2. 2. Persistent ulcer symptoms may be caused by gastric carcinoma, tuberculosis or syphilis. 3. 3. Persistent ulcer symptoms may be caused by successive ulcers at short intervals, new ulcers in slightly different locations being recognizable upon study. 4. 4. Persistent ulcer symptoms may be caused by complications of the ulcer or complications other than in the ulcer itself, many requiring operative interference. 5. 5. Allergy may cause repeated ulcers, may prevent healing or may produce symptoms simulating ulcer. 6. 6. Inadequate or improper treatment may prevent healing and thus prolong symptoms. 7. 7. The truly intractable peptic ulcer is a complicated ulcer, one prevented from healing by scarring, walled-off perforation, adhesions, deformities or obstruction, and should be recognized as a probable surgical case at the time of the initial study. 8. 8. Operation should not be performed in any case until careful and repeated studies have revealed true persistence of an ulcer or permanent deformity resulting therefrom.