Commentary |

Ulcer Surgery and Highly Selective Vagotomy—Y2K

Philip E. Donahue, MD
Arch Surg. 1999;134(12):1373-1377. doi:10.1001/archsurg.134.12.1373.
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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.

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Figure 1.

Annual death rate by race for patients with peptic ulcer (International Classification of Diseases, Ninth Revision [ICD-9] codes 531-534.9), 1979-1996.

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Figure 2.

Death rate by age group for patients with peptic ulcer (International Classification of Diseases, Ninth Revision [ICD-9] codes 531-534.9).

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