The old question Why does the stomach not digest itself? used to evoke endless discussion; the fact that it does digest itself, locally at least, in the case of peptic ulcer is equally mysterious and, of course, of far greater practical importance. The tremendous clinical and experimental work on record has led to the formulation of a variety of theories, seldom supported by adequate evidence. Embolic, toxic, chemical, bacteriologic or allergic factors, and not unusually a combination of part or all of them, may be emphasized. The true explanation still remains a challenge to medical progress.
When pathogenesis is not well understood, therapy also is a field for conflict and dispute. In the case of peptic ulcer the polemics have at times waxed widely and furiously. The battle still smolders occasionally not only between the advocates of medical versus surgical treatment but also between various methods in each group. Medically,
THE ACID FACTOR IN PEPTIC ULCER. JAMA. 1933;101(11):857–858. doi:10.1001/jama.1933.02740360037016
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