Studies on peptic ulcer

ABSTRACT

We collected for study 100 cases of peptic ulcer the diagnosis of which was verified by x-ray in seventy-two cases, by operation in twenty-one, and by autopsy in sevene have prepared seven tablesTable 1 shows that peptic ulcer is a disease that frequently occurs among persons in the active period of their lifeTable 2 indicates that peptic ulcer affects chiefly persons who are hard workers. It is also frequent among the jobless, in whom the neurogenic factor may play a role in the causation of peptic ulcerTable 3 demonstrates the presence of abdominal pain in every case of peptic ulcer in our series. It has been noted that more frequently than not, epigastric pain had relation to meals. The other symptoms in the order of Frequency are vomiting, sour eructations, nausea, constipation, etcTable 4 shows that normal total acidity, free HCl and combined HCl values may be obtained in an empty or fasting stomach and also one hour after Ewalds test meal. In our series we have noted more cases of peptic ulcer with normal acid values than with hyperacidity. In many cases the acid values are higher in an empty or fasting stomach than one hour after the test meal. This may be due to hypersecretion and retention of the gastric contents due to partial pyloric obstructionTable 5 indicates the more frequent occurrence of ulcers in the stomach than in the duodenum, the proportion being two to one. Gastric ulcers are found more frequently in the lesser curvature, and in the antrumTable 6 shows that hemorrhages in the form o melena or hematemesis occured in about one half of the total number of cases. Perforations occured in both gastric and duodenal ulcers, and recoveries were due to timely surgical intervention. Malignant degenrations occured in a few cases of gastric ulcer, but none occured in duodenal lesionsTable 7 demonstrates that with our cases of peptic ulcer, ascariasis has frequently been found associated, but probably there is no causal relationshipWe have briefly enumerated the different therories regarding the genesis of peptic ulcer. The neurogenic factor is probably fundamentally essential, operating in conjunction with some other predisposing or provocative factorsWe hve outlined an opinion on the proper diagnosis of peptic ulcer with special emphasis on x-ray pictures and gastroscopy.(Summary)