Modern Management of Duodenal Ulcer

Abstract

Chronic peptic ulcer of the duodenum is a common disease. It causes the loss of over two million working days per annum in the U.K. In Scotland, its sufferers occupy over one hundred thousand bed days, and, along with benign gastric ulcer it kills almost four hundred Scots per year.1,2' By the age of fifty about ten per cent of the male Scottish population will have been affected by it.

If it is not rare, neither is it new. The term peptic ulcer was first used in 1882 by Quincke, believing that pepsin was the prime culprit. Bilroth first performed his operation in 1881, so we have nearly a century of operative experience to draw from.

Yet despite this, there is still controversy over how this condition should be managed. Until recently our drug therapy was ineffective in altering the natural history of the disease, and even now has little place in recurrent ulceration. And trying to untangle the mass of surgical literature with many surgeons each promoting the virtues of one of the various manoeuvres, with at least nine major and a multitude of minor variants on offer, is not easy.