Nearly 85 per cent of the patients who present themselves for treatment of peptic ulcer are maintained satisfactorily on a medical regimen. Many are quickly relieved thereby and apparently remain symptom free afterward. Many, of course, continue to have symptoms, but these are tolerated and ameliorated sufficiently well to avert the necessity for more radical treatment. The remaining 15 per cent of the patients do not improve sufficiently, even on the most rigid medical therapy, to warrant its continuation. These are the patients in whom develop the manifestations and complications of peptic ulcer that have come to be considered as the unequivocal indications for surgical therapy. These indications are perforation, obstruction, hemorrhage and pain.
Since perforation constitutes an emergency situation, and its closure is not intended as definitive treatment, it may be excluded from a discussion limited to surgery of the ulcer diathesis. If the first of the other three
Glenn F. PRESENT STATUS OF THE SURGICAL TREATMENT OF PEPTIC ULCER. JAMA. 1951;145(11):790-794. doi:10.1001/jama.1951.02920290016004