Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1985 Jun;201(6):741–751. doi: 10.1097/00000658-198506000-00011

The management of gastric ulcers. A current review.

R B Adkins Jr, J B DeLozier 3rd, H W Scott Jr, J L Sawyers
PMCID: PMC1250809  PMID: 4004386

Abstract

In the past 10 years, 163 patients with documented gastric ulcers were treated at Vanderbilt University and Metropolitan Nashville General Hospitals. One hundred thirty-five were initially managed medically. Medical therapy was successful in 58 patients (43%) in this group. Twenty-eight (17%) patients required surgical treatment initially. An additional 77 patients (57%) became candidates for surgical management when their medical management failed. Of this group, 40 now have been surgically treated and 37 still have symptoms while on medical treatment. Three patients being treated for benign ulcers, two for as long as six years each, were found to have carcinoma of the stomach diagnosed by subsequent endoscopy and biopsy in one and by laparotomy with gastrectomy to include the ulcer in two. We consider subtotal gastrectomy or surgical resection of the antrum, including the ulcer site, to be the preferred surgical treatment for gastric ulcers, and this was done in 50 cases. Vagotomy was done in addition to the antrectomy in 31 of these, and in addition to the subtotal resection in 11. Two patients who had vagotomy and resection subsequently developed a marginal ulcer. One of these who had a subtotal resection and vagotomy healed with medical treatment. The one who had a vagotomy and antrectomy required a second vagotomy for a missed vagus nerve. Gastrointestinal endoscopy in the past 10 years has improved to the point that very few malignant ulcers are missed by endoscopic biopsy. Large ulcers, those that perforate or continue to bleed, and those that fail to heal on medical treatment for a maximum of 2 to 3 months should be submitted to an antrectomy that includes the ulcer. Vagotomy should be added in selected cases.

Full text

PDF
741

Images in this article

744FIG. 2.
on p.744

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ADAMS J. E., SAWYERS J. L., CLASSEN K. L., SCOTT H. W. Management of gastric ulcer. Rocky Mt Med J. 1959 Mar;56(3):81–84. [PubMed] [Google Scholar]
  2. Abe S., Ogawa Y., Nagasue N., Sasaki Y., Akamizu H., Hirose S., Yukaya H., Suehiro S. Early gastric cancer: results in a general hospital in Japan. World J Surg. 1984 Jun;8(3):308–314. doi: 10.1007/BF01655060. [DOI] [PubMed] [Google Scholar]
  3. Adkins R. B., Jr, Scott H. W., Jr Surgical procedures in patients aged 90 years and older. South Med J. 1984 Nov;77(11):1357–1364. doi: 10.1097/00007611-198411000-00003. [DOI] [PubMed] [Google Scholar]
  4. Baron J. H. Current views on pathogenesis of peptic ulcer. Scand J Gastroenterol Suppl. 1982;80:1–10. [PubMed] [Google Scholar]
  5. Cade D., Allan D. Long term follow-up of patients with gastric ulcers treated by vagotomy, pyloroplasty and ulcerectomy. Br J Surg. 1979 Jan;66(1):46–47. doi: 10.1002/bjs.1800660114. [DOI] [PubMed] [Google Scholar]
  6. Davis Z., Verheyden C. N., Van Heerden J. A., Judd E. S. The surgically treated chronic gastric ulcer: an extended followup. Ann Surg. 1977 Feb;185(2):205–209. doi: 10.1097/00000658-197702000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Domellöf L., Eriksson S., Janunger K. G. Late precancerous changes and carcinoma of the gastric stump after Billroth I resection. Am J Surg. 1976 Jul;132(1):26–31. doi: 10.1016/0002-9610(76)90284-1. [DOI] [PubMed] [Google Scholar]
  8. Elashoff J. D., Grossman M. I. Trends in hospital admissions and death rates for peptic ulcer in the United States from 1970 to 1978. Gastroenterology. 1980 Feb;78(2):280–285. [PubMed] [Google Scholar]
  9. Elder J. B., Ganguli P. C., Gillespie I. E. Cimetidine and gastric cancer. Lancet. 1979 May 12;1(8124):1005–1006. doi: 10.1016/s0140-6736(79)92757-0. [DOI] [PubMed] [Google Scholar]
  10. Freston J. W. Cimetidine: II. Adverse reactions and patterns of use. Ann Intern Med. 1982 Nov;97(5):728–734. doi: 10.7326/0003-4819-97-5-728. [DOI] [PubMed] [Google Scholar]
  11. Herrington J. L., Jr, Scott H. W., Jr, Sawyers J. L. Experience with vagotomy--antrectomy and Roux-en-Y gastrojejunostomy in surgical treatment of duodenal, gastric, and stomal ulcers. Ann Surg. 1984 May;199(5):590–597. doi: 10.1097/00000658-198405000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Isenberg J. I., Peterson W. L., Elashoff J. D., Sandersfeld M. A., Reedy T. J., Ippoliti A. F., Van Deventer G. M., Frankl H., Longstreth G. F., Anderson D. S. Healing of benign gastric ulcer with low-dose antacid or cimetidine. A double-blind, randomized, placebo-controlled trial. N Engl J Med. 1983 Jun 2;308(22):1319–1324. doi: 10.1056/NEJM198306023082203. [DOI] [PubMed] [Google Scholar]
  13. Johnson H. D. Gastric ulcer: classification, blood group characteristics, secretion patterns and pathogenesis. Ann Surg. 1965 Dec;162(6):996–1004. doi: 10.1097/00000658-196512000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Kraft R. O. Long-term results of vagotomy and pyloroplasty in the treatment of gastric ulcer disease. Surgery. 1984 Apr;95(4):460–466. [PubMed] [Google Scholar]
  15. Lewis J. H. Treatment of gastric ulcer. What is old and what is new. Arch Intern Med. 1983 Feb;143(2):264–274. [PubMed] [Google Scholar]
  16. Meyer J. H., Schwabe A., Isenberg J. I., Sturdevant R. A., Grossman M. I., Passaro E., Jr Treatment of peptic ulcer disease- a symposium. West J Med. 1977 Apr;126(4):273–287. [PMC free article] [PubMed] [Google Scholar]
  17. Papachristou D. N., Agnanti N., Fortner J. G. Gastric carcinoma after treatment of ulcer. Am J Surg. 1980 Feb;139(2):193–196. doi: 10.1016/0002-9610(80)90252-4. [DOI] [PubMed] [Google Scholar]
  18. Piper D. W., Greig M., Coupland G. A., Hobbin E., Shinners J. Factors relevant to the prognosis of chronic gastric ulcer. Gut. 1975 Sep;16(9):714–718. doi: 10.1136/gut.16.9.714. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Reed P. I., Smith P. L., Haines K., House F. R., Walters C. L. Effect of cimetidine on gastric juice N-nitrosamine concentration. Lancet. 1981 Sep 12;2(8246):553–556. doi: 10.1016/s0140-6736(81)90940-5. [DOI] [PubMed] [Google Scholar]
  20. Reed P. I., Smith P. L., Haines K., House F. R., Walters C. L. Gastric juice N-nitrosamines in health and gastroduodenal disease. Lancet. 1981 Sep 12;2(8246):550–552. doi: 10.1016/s0140-6736(81)90939-9. [DOI] [PubMed] [Google Scholar]
  21. Sawyers J. L., Scott H. W., Jr, Graham C. Clinical trial of vagotomy and pyloroplasty in the treatment of benign gastric ulcer. Am J Surg. 1971 Feb;121(2):119–121. doi: 10.1016/0002-9610(71)90087-0. [DOI] [PubMed] [Google Scholar]
  22. Scott H. W., Jr, Adkins R. B., Jr, Sawyers J. L. Results of an aggressive surgical approach to gastric carcinoma during a twenty-three-year period. Surgery. 1985 Jan;97(1):55–59. [PubMed] [Google Scholar]
  23. Silverstein F. E. Peptic ulcer: an overview of diagnosis. Hosp Pract. 1979 Nov;14(11):78-83, 85-7. doi: 10.1080/21548331.1979.11707645. [DOI] [PubMed] [Google Scholar]
  24. Taylor R. H., Menzies-Gow N., Lovell D., La Brooy S. J., Misiewicz J. J. Misleading response of malignant gastric ulcers to cimetidine. Lancet. 1978 Apr 1;1(8066):686–688. doi: 10.1016/s0140-6736(78)90799-7. [DOI] [PubMed] [Google Scholar]
  25. Thomas W. E., Thompson M. H., Williamson R. C. The long-term outcome of Billroth I partial gastrectomy for benign gastric ulcer. Ann Surg. 1982 Feb;195(2):189–195. doi: 10.1097/00000658-198202000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. VISICK A. H. A study of the failures after gastrectomy. Ann R Coll Surg Engl. 1948 Nov;3(5):266–284. [PMC free article] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES