Peptic ulcer: surgical treatment.

Abstract

Peptic Ulcer-Langman BRITSH MEDICAL JOURNALj healing, probably owing in part to the difficulty of assessing changes in a deformed duodenal cap and in part because the doses required of anticholinergic drugs may be considerably higher than those commonly recommended. The newer anticholinergic preparations (such as glycopyrrolate, isopropamide, poldine, and propantheline) probably have a more selective action on the stomach than atropine, but similar side-effects do occur.It has been claimed that when given in the maximum tolerated doses anticholinergic preparations will reduce the gastric acid secretory response by half3" and that they will reduce the symptomatic relapse rate and complication rates36; the drugs used in these studies were poldine and propantheline, respectively. More Oestrogens.-Though Truelove 4 found stilboestrol to be an effective treatment in duodenal ulcer in men, there is a high incidence of side-effects of mastitis and impotence. Oestrogenic preparations which are free of side-effects and of therapeutic value have yet to be found, and hence drugs of this group do not seem to have any clear place in routine management. Gastric Freezing and IrradiationThese forms of treatment are essentially based on the hope that they will induce necrosis and hypoplasia, which is particularly prominent in mucosal secretory cells. The initial promise of gastric freezing (carried out by circulating alcohol at -20°C. through an intragastric balloon connected to peroral cannulae) has not been borne out by further experience, and a disturbing feature of the treatment has been the incidence of complications-which include melaena, pyloric obstruction, oesophageal rupture or stricture, and gastric ulcer. Gastric acidity can be reduced to a variable and unpredictable degree by x-ray treatment. The treatment involves a high dose of radiation, and in consequence there is a risk of late complications of leukaemia and perhaps cancer. Radiation therapy may have a limited place in the treatment of patients with intractable symptoms in whom surgery is for other reasons inadvisable.Surgical Treatment J. L. DAWSON,* M.S., F.R.C.S. British Medical Journal, 1969, 4, 102-105 Any current surgical journal is likely to contain several articles on the surgical treatment of peptic ulcer. Unfortunately almost all of these contributions represent the results of a particular operation, applied to a selected group of patients, followed up by the surgeons who did the operation.The various operations are judged by (1) of the world with another or even one part of a country with another, because the incidence of the disease varies considerably-for example, the incidence of duodenal ulcer in the male population is higher in Scotland than in the southeastern area of England. The incidence of duodenal ulcer has risen sharply since the beginning of this century, so that the results of surgery in past decades are not necessarily valid today.The value of a properly controlled trial was demonstrated by a recent series reported from Leeds,46 ...