Abstract

Abstract:It is suggested that chronic peptic ulcer is a result of two major factors: (1) trauma, in particular from a high acid-peptidase secretion; and (2) the nutritional state of the mucosal epithelium, which in turn is related to its capillary flow. The importance of the latter factor has too often been overlooked, and in this study, evidence is presented to support the concept that ulceration occurs most frequently in areas of mucosal vascular insufficiency. These areas are not random in their distribution but are eccentric in location and are at sites of potential ischemia. This ischemia may be exaggerated by decrease in large vessel flow, muscle spasm, and intraluminal distention. The most useful surgical procedures that have developed in the treatment of chronic peptic ulcer have the effect of improving mucosal blood flow by the establishment of additional vascular channels from the superior mesenteric circulation (gastrojejunostomy), by relief of muscle spasm and intraluminal distention (gastrojejunostomy, pyloroplasty, vagotomy), by removal of the areas of vascular insufficiency (gastric resection), and by decreasing the trauma of the acid-peptidase factor (vagotomy), and possibly by antrectomy. The selection of a particular surgical procedure to modify the causative factors will depend upon the physiologic alterations each patient presents.