Evaluation of present day treatment of peptic ulcer.

The treatment of peptic ulcer is an ever increasing problem to the internist and surgeon alike. Those who attempt to treat the ulcer patient consrientiously are daily confused by the multiplicity of articles and conflicting results found in the literature today. There are many advocates of a strict antacid and dietary regimen and almost as many others claim that antacids and diet are valueless. Many substances have been proposed as sure cures for the peptic ulcer patient, only to have this claim upset by reports indicating that placebos are just as effective. It is extremely difficult for the average busy practitioner to weigh the evidence and sift the facts in an attempt to determine what actually constitutes the most adequate present day method of therapy. It is the purpose of this paper to summarize and clarify the modern treatment of peptic ulcer. In 1828 Abercrombie (1) first introduced the use of milk, farinaceous foods and lime water in the treatment of this disease. Johnson (2) just three years later introduced the use of soda, magnesia arid chalk. In 1835 Cruveilhier (3) emphasized the use of good dietary hygiene and in 1872 Fox (4) stressed the importance of rest. Since that time the treatment of peptic ulcer has been modified very little. The basis for the moderii day treatment of peptic ulrer was established by the year 1872; only antispasmodics, sedatives, and psychotherapy have been added. The etiology of peptic ulcer remains almost as ohmwe as it was in 1872. S o single etiologic factor has been found but many factors have been presented as playing a role in the cmmhon of this disease. Decreased tissue resistance secondary to the loss of the normal mucous harrier has been advanced by some authors as the basic cause of peptic ulceration. No good evidence has appeared to show a decrease in mucin content arid the use of gastric mucin in the treatment of peptic ulcer has been discouraging. Other investigators have postulated the presence of gastric atrophy as the Cause of decreased tissue resistance and