South African Medical Journal

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The treatment of chronic peptic ulceration

J.H. Louw


Gastric and duodenal ulcers are different entities. The duodenal ulcer is a problem for the physician while the gastric ulcer is a problem for the surgeon.

In duodenal ulcer the object of treatment is reduction of acid output by control or elimination of hypersecretion of gastric juice especially as far as the cephalic phase is concemed. In those cases that have earned surgical treatment gastric vagotomy is, therefore, of fundamental importance, and the best complementary procedure to eliminate the antral phase of gastric secretion is either antral resection or 'physiological antrectomy' by an adequate drainage operation.

In gastric ulcer the fear of carcinoma masquerading as a benign ulcer must still dictate the policy of management in our community. For this reason timely surgical intervention is recommended. Indeed, medical treatment without a thorough work-up to exclude malignancy is condemned as unscientific - I would go further and say, unethical. The main purpose of therapy is protection or removal of the sick gastric mucosa and the surgical treatment of choice remains distal gastrectomy which includes the ulcer.

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