Peptic ulcers and their complications

The incidence and management of peptic ulcer disease have changed considerably since the first surgical interventions, carried out less than a century ago. Operative techniques refined during the early second half of the twentieth century have become almost obsolete in today’s practice for two principal reasons. First, understanding of the aetiology of the disease process has taken a dramatic step forward with the discovery of Helicobacter pylori, now known to be associated with 95% of cases of duodenal ulceration. Second, the pharmacological development of histamine (H2)-receptor antagonists and, more recently, proton-pump inhibitors means that the control of acid secretion in the stomach is now achievable without resorting to invasive and often debilitating surgical procedures. Despite these advances, emergency presentations with either haemorrhage or visceral perforation continue to occur with relative frequency and it remains the responsibility of the surgical trainee to understand the fundamentals of patient management in these situations.