Treatment of Chronic Gastric and Duodenal Ulcer

Much of the confusion of thought and teaching which now exists regarding the surgical management of patients suffering from chronic gastric and chronic duodenal ulcer arises from the fact that in recent years it has become customary to class these two conditions together as one disease -peptic ulcer. It is true that chronic gastric and chronic duodenal ulcer have certain features in common; the early signs and symptoms presented by the two conditions are in many respects similar, the acid gastric chyme plays an all-important r6le in the perpetuation of the lesions, and the medical measures advocated for their treatment are almost identical. Nevertheless, the risk of malignant transformation, the degree of morbidity and the potentialities of disaster with the accompanying economic disturbances are factors which differ widely according to whether they are associated with chronic duodenal ulcer or with chronic ulcer of the stomach. Cancerous degeneration of a duodenal ulcer is such a rare event as to constitute a pathological curiosity, but the malignant transformation of a gastric ulcer is a potent factor to be reckoned with in treatment, and is indeed an ever-present menace which cannot be ignored. The surgical treatment of these two diseases also varies in many important details, and it is for these reasons in particular that I propose to discuss them separately. The distinction between these two types of chronic ulcer should be always maintained not only by the surgeon, but also by the physician, since the appreciation of the true site of an ulcer may have many repercussions in assessing the correct therapeutic and economic permutations of these all-too-common alimentary disorders of mankind.