Is the aggressive management of peptic ulcer justified by the data?

Abstract

Sophisticated and very effective means of diagnosing and treating peptic ulcers are now available. This entails considerable resource utilization in affluent western societies, all with resource limitations, which mean that the costs need to be balanced by the outcomes achieved--the benefits. Little attention has been paid to the risk to life and well-being posed by ulcer and the effect, if any, of the intervention on such risks. I present an analysis of the natural history of peptic ulcer including studies of the natural history of peptic ulcer including studies incorporating life-table analysis and a population comparison. The conclusions are clear. The possessors of a peptic ulcer have, in general, a normal life expectancy. A major cause of ulcer-related death in the past was postoperative. Symptoms and workloss have diminished after the introduction of H2 antagonists, but no evidence is yet available of any change in the rates of bleeding, perforation or death from ulcer related to modern methods of diagnosis and management. The risk of major complication is approximately 0.025/year over the next 10 years. The risk of death is greatest in elderly women with gastric ulcer and in those on corticosteroids. The data suggest to me that the costs of aggressive investigation and treatment of peptic ulcer need to be justified by the dangers averted.