Reassessment of the management of benign gastric ulcer with achlorhydria

Previous reports of benign gastric ulcer with achlorhydria have recommended surgical removal of the ulcer, even though a malignant process had not been demonstrated. We report a patient with achlorhydria and a gastric ulcer who, at exploration 4 weeks after discovery, had only a healed ulcer. Its benign nature was demonstrated by endoscopic biopsies and cytology and confirmed at surgery. The patient has remained achlorhydric on follow-up and has not had further ulcers. We recommend that, after multiple endoscopic biopsies and cytology have adequately excluded a malignant process, a gastric ulcer be followed to complete healing, even in the presence of achlorhydria. If healing is incomplete by 6-12 weeks, surgical intervention should be contemplated, just as for more routine gastric ulcers.