Management of Chronic Peptic Ulcer*
In recent years, a large number of articles dealing with the subject of chronic peptic ulcer have appeared in the literature. Many writers have considered chiefly the problem of etiology, while others have advocated new and unusual forms of therapy. In an effort to sift the wheat from the chaff, we have found it necessary to direct our thoughts to the fundamental principles of the physiology of the gastrointestinal tract. It seems to us quite evident that major symptoms of this disease result from abnormal disturbances in motility and secretion. The effects of local inflammation within the stomach or at the site of the ulcer appear to be secondary factors. In this discussion the various conceptions of etiology will be discussed and the principles of treatment will be considered. First, however, some general observations will be made.
Chronic peptic ulcer does not occur in the lower animals; it distinctly appears to be a disease of civilized man. As a cause of chronic indigestion, it surpasses in frequency all other abnormal states with the exception of chronic disease of the gallbladder. However, during the period of man’s greatest mental and nervous activity—between the ages of twenty-five and fifty—it has no close rival. Among those patients who come to us complaining of chronic recurring indigestion and in whom we are able to make the diagnosis of a gastric or duodenal ulcer, there appears to be a definite constitutional type. This apparent predisposition is not related to the physical appearance of. . .