Comparison between medical and elective surgical treatment of peptic ulcers

During the last decades we have learnt how to treat chronic peptic ulcer disease both with surgery (mainly vagotomy) and with long term medical treatment (mainly H2-receptor antagonists) with great success and safety. Although much attention has lately been given to 'cytoprotective' agents, it is still too early to regard them as alternatives to acid reducing treatment in the long term management of severe peptic ulcer disease. The importance of campylobacter pylori for long term outcome is today only speculative. Only a few randomized studies have been performed comparing surgical and medical treatment. The hitherto published studies involve small numbers of patients or do not use an optimal dosage of the drug given. Nevertheless for most patients with severe peptic ulcer disease one can conclude that we have both medical and surgical alternatives of comparable efficacy and safety to choose among. The final decision if an elective operation or not should be performed must be based on the preference of the individual patient.