Stenosing Small-Intestinal Ulcers

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PRIMARY small-bowel ulcers are usually circumferential, solitary, located in the distal part of the small intestine, and may be complicated by bleeding, obstruction, and perforation. The origin of this type of ulceration is not known, so the ulcers have been classified as primary, idiopathic, small-intestinal ulcers.

The incidence of primary, idiopathic, small-bowel ulcer was low until 1964. Hangos,1 in a survey of the world literature to 1959, found only 150 such cases, and Watson,2 four years later, in a similar survey reported on only 170 cases. Although the description of the first case is attributed by Watson2 to Matthew Baillie in 1805, less than 200 cases were reported through 1965.

Baker, Schrader, and Hitchcock,3 and Lindholmer, Nyman, and Räf,4 in late 1964 reported that enteric-coated potassium with diuretics could cause such ulcers. Stimulated by their findings, studies5 were done in 415 hospitals in the United States and 73 hospitals in foreign countries, and the number of cases rapidly increased from 170 to 500. In about 50 percent of the cases, the intake of enteric-coated potassium or enteric-coated potassium with thiazide was implicated as a possible etiologic agent. Morgenstern, Freilich, and Panish6 reported 17 patients in whom such small-intestinal ulcerations had been due to enteric-coated potassium or thiazide drugs containing potassium, and showed experimentally in dogs that such ulcerations could be caused by thiazide with potassium, but not by thiazide alone. The ulcerogenic effect of enteric-coated potassium compounds has been shown experimentally by Bokelman and associates7 and Diener and associates8 in. . .



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