Management of Peptic Ulcer

Abstract

Although the pattern of peptic ulcer is probably changing, it is still a large health problem in this country.

The majority are easily diagnosed by barium meal examination, but endoscopy may reveal a few radiologically missed gastric ulcers. Acid secretory measurements are of limited proven value.

The principal measures in medical treatment are frequent meals, extra milk, antacids and anticholinergics. Liquorice preparations are currently showing promise but require further careful evaluation.

Operation for duodenal ulcer aims at permanently reducing gastric acid and pepsin secretion, anb this can be achieved by vagotomy and drainage procedure or by partial gastrectomy. The main considerations are mortality, risk of recurrent ulcer and post-operative sequelae. Gastric ulcer is still most often treated successfully by Billroth I partial gastrectomy,

The management of the acute complications, perforation and bleeding, and of the rare Zollinger-Ellison syndrome are discussed.