The Ulcer Patient in General Practice [antikvár]

Peptic Ulceration Peptic ulceration is a condition of equal concern to the general practitioner, the internist and the specialist gastroenter-ologist. The reasons for its importance are to be found in the natural history of ulcer disease and its high prevalence. Some 7% of the population will be affected by duodenal ulceration at some time in their lives, and the annual incidence of new cases is roughly 2.9/1,000. During the last ten years, the number of hospital admissions for duodenal ulcer has fallen by half, and nowadays nearly all patients with uncomplicated ulcers are treated outside hospital. Most patients referred to hospital are cases of gastric ulcer, which heal slowly. The natural course of ulcer disease is characterized by numerous episodes of spontaneous healing, frequent relapses and occasional complications. For example, in the first year after a gastric ulcer has been diagnosed, complications can be expected in 1 % of patients. When an ulcer first occurs, accompanied by a complication such as bleeding or perforation, the risk of subsequent complications is high. Complications are also more frequent in elderly patients. Of the patients who suffer from complications approximately one patient in ten will die. Peptic ulcers of the stomach and duodenum are certainly not a homogenous disease group. They differ in their pathogenesis, symptoms and course. Their only common feature seems to be the final link in the pathophysiologic chain, namely the destruction of the production site by its own product. As far back as 1910, Schwarz coined the aphorism: "No ulcer without acid." Since then, there have been numerous other hypotheses for the pathogenesis - circulatory disturbances, chronic gastritis, the presence of microbial pathogens, reflux of bile acids from the lower duodenum into the stomach and the functionally-related duodenal bulb - but all of them require further investigation. Progress in fibre endoscopy and the advent of modern pharmacotherapy have widened our knowledge of the natural course and healing of peptic ulceration. Endoscopy now enables the internist to study intravital macropathol-ogy, and thanks to modern drugs, the natural course of the disease can now be changed for the better. These advances in the diagnosis and therapy of peptic ulceration - a veritable "community disease" - are the subject of this book.