Abstract

A 48-year-old man was believed to have an osteoarthritis of the spine. He was suffering with severe and incapacitating backache. There were no digestive symptoms. A penetrating duodenal ulcer was found. Appropriate treatment of this relieved the backache.A 57-year-old man, a known diabetic, developed precordial pain. This was related to the development of an acute penetrating duodenal ulcer. Complete relief of pain followed the institution of appropriate dietary, antacids and antispasmodics. Indigestion was conspicuously absent and there was never any abdominal pain.An harassed 57-year-old executive was demonstrated to have an acute gastric ulcer as the explanation for his indigestion. The ulcer healed promptly and he has remained well. The promptness of the healing was very impressive and simplified greatly the decision as to whether the lesion was benign or malignant in character.A 79-year-old man with a six weeks history of indigestion was found to have an acute gastric ulcer and an old duodenal ulcer. On conservative treatment the gastric ulcer was observed to heal.These two patients are older men with recent abdominal symptoms. In both of them the digestive symptoms subsided promptly and there was a rapid healing of the ulcer which could be seen to occur in the x-ray studies. The presence of free hydrochloric acid gives a certain amount of comfort, even though 45 per cent of patients with gastric carcinoma have free hydrochloric acid and 12 per cent actually have hyperchlorhydria. When improvement such as this does not follow within a very few weeks, there is reason for concern and a more aggressive approach must be employed. Let us consider the following problem.A 35-year-old man developed an ulcer on the lesser curvature of the stomach. The ulcer was symptomatic for eight months before the first x-rays were made. A good therapeutic response followed adherence to an ordinary “ulcer regime.” Because of apparent poor cooperation of the patient and the continued presence of pain, a subtotal gastric resection was carried out about two years after the onset of the initial symptoms. There followed an interval of eight years of fairly good health before evidence of wide-spread malignant disease developed. The tissue, originally considered to be that of a benign gastric ulcer, on re-study showed evidence of carcinoma.