Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

SURGICAL MANAGEMENT OF GASTRIC ULCER

SURGICAL MANAGEMENT OF GASTRIC ULCER Abstract Whether a given gastric ulcer is benign or malignant can be decided only by the pathologist examining the excised specimen. In a series of 155 patients hospitalized with the diagnosis of gastric ulcer, agreement between physician and surgeon that the ulcer was benign occurred in about 7% of the cases. In 5% of the patients the ulceration is believed to have been precipitated by gastric irritants and stimulants, such as medicaments taken habitually. Medical management, including withdrawal of such irritants, should be tried; if this fails a surgical program adapted to the location of the lesion is recommended. The postoperative course of patients with conservative forms of gastric resection was compared with that of patients after radical resections. In a series of 76 patients those with conservative resections were underweight in 42% and troubled with moderate or severe dumping symptoms in 2.6% of the cases, while the corresponding figures for radical resections were 80% and 47%. Routine radical resection for gastric ulcer is not justified by the known incidence of malignancy. Hope lies in better diagnosis and in earlier, rather than more radical, surgery. References 1. Klotz, A. P.; Kirsner, J. B.; and Palmer, W. L.: Evaluation of Gastroscopy , Gastroenterology 27:221-226 ( (Aug.) ) 1954. 2. Seybolt, J. F., and Papanicolaou, G. N.: Value of Cytology in Diagnosis of Gastric Cancer , Gastroenterology 33:369-377 ( (Sept.) ) 1957. 3. Hayes, M. A.: Gastric Ulcer Problem , Gastroenterology 29:609-620 ( (Oct.) ) 1955. 4. Ravdin, I. S.: Personal communication to the authors. 5. Roth, J. A.; Ivy, A. C.; and Atkinson, A. J.: Caffeine and "Peptic" Ulcer: Relation of Caffeine and Caffeine-Containing Beverages to Pathogenesis, Diagnosis and Management of "Peptic" Ulcer , J. A. M. A. 126:814-820 ( (Nov. 25) ) 1944.Crossref 6. Schneider, E. M.: Aspirin as Gastric Irritant , Gastroenterology 33:616-620 ( (Oct.) ) 1957. 7. Kirsner, J. B., and Ford, H.: Phenylbutazone (Butazolidin)—Studies on Stimulation of Gastric Secretion and Formation of Peptic Ulcer in Man , Gastroenterology 29:1-17 ( (July) ) 1955. 8. Villarreal, R.; Ganong, W. F.; and Gray, S. J.: Effect of Adrenocorticotrophic Hormone upon Gastric Secretion of Hydrochloric Acid, Pepsin and Electrolytes in Dog , Am. J. Physiol. 183:485-494 ( (Dec.) ) 1955. 9. Beman, F. M.; Knoll, H. C.; and DeLor, C. J.: Effect of Reserpine on Gastric Secretion , abstracted, Clin. Res. Proc. 3:131 ( (April) ) 1955. 10. Woodward, E. R.; Slotten, D. S.; and Tillmans, V. C.: Mechanism of Alcoholic Stimulation of Gastric Secretion , Proc. Soc. Exper. Biol. & Med. 89:428-431 ( (July) ) 1955.Crossref 11. Johnson, H. D.: Associated Gastric and Duodenal Ulcers , Surg. Gynec. & Obst. 102:287-292 ( (March) ) 1956. 12. Dragstedt, L. R.: Concept of Etiology of Gastric and Duodenal Ulcers , Gastroenterology 30:208-220 ( (Feb.) ) 1956. 13. Denkewalter, F. R., and Watman, R. N.: Conservative Surgical Treatment of All Gastric Ulcers , A. M. A. Arch. Surg. 75:558-565 ( (Oct.) ) 1957. 14. Wangensteen, O. H.: Cancer of Esophagus and Stomach , New York, American Cancer Society, Inc., 1951. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

SURGICAL MANAGEMENT OF GASTRIC ULCER

JAMA , Volume 171 (15) – Dec 12, 1959

Loading next page...
 
/lp/american-medical-association/surgical-management-of-gastric-ulcer-ZpBrKJdrP4

References (15)

Publisher
American Medical Association
Copyright
Copyright © 1959 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.1959.03010330018006
Publisher site
See Article on Publisher Site

Abstract

Abstract Whether a given gastric ulcer is benign or malignant can be decided only by the pathologist examining the excised specimen. In a series of 155 patients hospitalized with the diagnosis of gastric ulcer, agreement between physician and surgeon that the ulcer was benign occurred in about 7% of the cases. In 5% of the patients the ulceration is believed to have been precipitated by gastric irritants and stimulants, such as medicaments taken habitually. Medical management, including withdrawal of such irritants, should be tried; if this fails a surgical program adapted to the location of the lesion is recommended. The postoperative course of patients with conservative forms of gastric resection was compared with that of patients after radical resections. In a series of 76 patients those with conservative resections were underweight in 42% and troubled with moderate or severe dumping symptoms in 2.6% of the cases, while the corresponding figures for radical resections were 80% and 47%. Routine radical resection for gastric ulcer is not justified by the known incidence of malignancy. Hope lies in better diagnosis and in earlier, rather than more radical, surgery. References 1. Klotz, A. P.; Kirsner, J. B.; and Palmer, W. L.: Evaluation of Gastroscopy , Gastroenterology 27:221-226 ( (Aug.) ) 1954. 2. Seybolt, J. F., and Papanicolaou, G. N.: Value of Cytology in Diagnosis of Gastric Cancer , Gastroenterology 33:369-377 ( (Sept.) ) 1957. 3. Hayes, M. A.: Gastric Ulcer Problem , Gastroenterology 29:609-620 ( (Oct.) ) 1955. 4. Ravdin, I. S.: Personal communication to the authors. 5. Roth, J. A.; Ivy, A. C.; and Atkinson, A. J.: Caffeine and "Peptic" Ulcer: Relation of Caffeine and Caffeine-Containing Beverages to Pathogenesis, Diagnosis and Management of "Peptic" Ulcer , J. A. M. A. 126:814-820 ( (Nov. 25) ) 1944.Crossref 6. Schneider, E. M.: Aspirin as Gastric Irritant , Gastroenterology 33:616-620 ( (Oct.) ) 1957. 7. Kirsner, J. B., and Ford, H.: Phenylbutazone (Butazolidin)—Studies on Stimulation of Gastric Secretion and Formation of Peptic Ulcer in Man , Gastroenterology 29:1-17 ( (July) ) 1955. 8. Villarreal, R.; Ganong, W. F.; and Gray, S. J.: Effect of Adrenocorticotrophic Hormone upon Gastric Secretion of Hydrochloric Acid, Pepsin and Electrolytes in Dog , Am. J. Physiol. 183:485-494 ( (Dec.) ) 1955. 9. Beman, F. M.; Knoll, H. C.; and DeLor, C. J.: Effect of Reserpine on Gastric Secretion , abstracted, Clin. Res. Proc. 3:131 ( (April) ) 1955. 10. Woodward, E. R.; Slotten, D. S.; and Tillmans, V. C.: Mechanism of Alcoholic Stimulation of Gastric Secretion , Proc. Soc. Exper. Biol. & Med. 89:428-431 ( (July) ) 1955.Crossref 11. Johnson, H. D.: Associated Gastric and Duodenal Ulcers , Surg. Gynec. & Obst. 102:287-292 ( (March) ) 1956. 12. Dragstedt, L. R.: Concept of Etiology of Gastric and Duodenal Ulcers , Gastroenterology 30:208-220 ( (Feb.) ) 1956. 13. Denkewalter, F. R., and Watman, R. N.: Conservative Surgical Treatment of All Gastric Ulcers , A. M. A. Arch. Surg. 75:558-565 ( (Oct.) ) 1957. 14. Wangensteen, O. H.: Cancer of Esophagus and Stomach , New York, American Cancer Society, Inc., 1951.

Journal

JAMAAmerican Medical Association

Published: Dec 12, 1959

There are no references for this article.