[Indications for elective surgery of stomach ulcer. A physician's views]

The surgical as well as the medical treatment of peptic ulcer disease has changed significantly during the last 15 years, and as a consequence, indications for surgery have also changed. It is pointed out that "persistent ulcer" is not as clear an indication as often thought because persistence is only relative, depending on length and intensity of treatment. Furthermore studies have shown bad results after surgery for ulcers "resistant" to medical treatment. Frequent relapses after short-term treatments represent an indication for either prophylactic long-term medical treatment or surgery. Long-term treatment with H2-antagonists has only rare, benign and reversible side-effects. A proximal gastric vagotomy has a near-zero mortality and complications are rare, but the recurrence rate varies from 5 til 30% in five years, depending on the surgeon's skill. The indication for surgery should therefore also consider the local recurrence rate. Some ulcers relapse during prophylactic long-term medical treatment, and this is often considered an indication for surgery. It should however be kept in mind that the efficacy of surgery is only due to acid reduction, and therefore a similar effect can be obtained by adjusting the acid inhibitory drugs to the same level of acid secretion. A few patients who need long-term treatment cannot afford to buy the drugs and ask for a "free" operation, and some patients are so worried about taking drugs that they should be offered an operation.