Comments on the incidence and natural history of gastric and duodenal ulcer.

Incidence Studies of the incidence of peptic ulceration can be no more than a mass of dull statistics, or, on the other hand, can raise fascinating problems-which are largely unanswered. For example, there have been several studies showing that there is a higher frequency of duodenal ulcers in the North of this island as compared to the South; and again there is good evidence the incidence of new duodenal ulcer cases in this country has decreased in recent years. There is, or probably more accurately was, a higher incidence in urban than rural areas. The reasons for these differences are unknown. One of the major problems in incidence studies is that of diagnosis, or definition, of an ulcer subject. All methods of diagnosis, clinical, radiological, gastroscopic, laparotomy and even autopsy are open to criticism; the latter, for example, depends, to no small extent, on the zeal of the observer. It is extremely difficult, I believe, to obtain 100% accuracy in diagnosis, and I am sure there are many men who have been labelled as having duodenal ulcers on inadequate evidence, but, on the other hand, there are some in whom the diagnosis has been missed. It would be easy to devote all the time available to discussing this problem, but I must limit my comments to two points. Firstly, I would like to stress the importance, particularly in the case of acute ulcers, of examining patients during a period of actual symptoms, not after first being treated at home, then waiting for an out-patient appointment, with a further delay for a barium meal. Secondly, a passing comment on the radiological evidence of healing in duodenal ulcer. This is, in my opinion, mainly guess-work, and unless one has demonstrated an ulcer crater it is, by and large, a waste of time, and unnecessary irradiation of the patient.