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Philip E. Donahue, MD
Chicago, Ill

Arch Surg. 1999;134:1373-1377.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

WHILE ulcerations of the stomach and duodenum remained common entities in the latter half of the 20th century, the number of operations performed for ulcer declined remarkably. Medical treatments became effective as specific medications (the histamine-receptor antagonists and proton-pump inhibitors [PPIs]) eliminated the deleterious effects of intraluminal acid, greatly reducing the need for operations.¹ Subsequently, bacterial infection was proven to be a major risk factor for gastric and duodenal ulcers, especially for ulcer recurrence, which was eliminated in 98% of those at risk by antibiotics directed against Helicobacter species.^2-3 For the first time in history, medical treatments for ulcer were clearly more effective than ulcer operations; ulcer surgery, once the only "definitive" therapy, is perceived as a heroic intervention, reserved for patients without other alternatives.

In the past 2 decades the advantages of highly selective vagotomy (HSV) in treating ulcers have been widely recognized; HSV is . . . [Full Text of this Article]

BACKGROUND


MEDICAL TREATMENT: 1950-1985

MEDICAL TREATMENT SINCE 1985: ANTIBIOTICS BECOME AN IMPORTANT PART OF TREATMENT

ULCER SURGERY: 1950-1985

HAS THE INCIDENCE OF ULCER CHANGED?

FEWER PERFORATIONS AND PEPTIC STRICTURES: DUE TO BETTER TREATMENT?

WHICH PATIENTS REQUIRE OPERATION? SHOULD SOME PATIENTS RECEIVE HSV?

CURRENT PERFORMANCE OF HSV BY AMERICAN RESIDENT SURGEONS

MINIMALLY INVASIVE OPERATIONS—A REPRIEVE FOR HSV?

CONCLUSIONS AND SUMMARY


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