The natural history of gastric ulcer in a community: four-year study

All (151) adult patients in north-east Scotland newly diagnosed in one year (1967) as having a supposedly benign definite gastric ulcer crater were studied after a minimum of four years, with a 98 per cent follow-up. Incidence and male to female ratio both increase with advancing age. Ulcers of the body of the stomach were twice as common as ulcers of the antral region. Major coincidental disease was present in 59 per cent of all patients and in 97 per cent of those dying, and was the chief cause of death. Twenty-one patients presented with bleeding but only one other bled subsequently. One patient presented with perforation of gastric ulcer. Two ulcers proved to be malignant. The effect of associated duodenal ulceration on presentation and course was not great. There was a direct correlation between short durations of symptoms and increasing age and mortality. Fifty-five per cent of the medically treated and 60 per cent of the surgically treated patients were alive and entirely free from gastric ulcer symptoms at the end of four years; the respective mortalities were 18-2 per cent and 20-3 per cent. For the whole series, life expectation was significantly reduced in the females, but not in the males.