Clinical data and characteristics differentiating types of peptic ulcer.

The widespread incidence of peptic gastroduodenal ulcer represents a social and economic factor of some consequence. Over the last 100 years much attention has therefore been devoted to the subject, but not even on the fundamental questions of the origin and essential nature of ulcers has agreement been reached. The cause lies in the considerable variability of the clinical manifestations and characteristics of the disease in individual patients. Observers are particularly struck by the varying incidence of the disease, changing not only according to locality, and to the age, social, and possibly racial composition of the population, but also with time (cohort phenomenon) (Billington, 1965; Demole and Ulman, 1964; Lazarus, 1964; Masek, 1956; May, 1958; Schade, 1958; Straub and Schornagel, 1958; Susser and Stein, 1962; Watkinson, 1960). In the clinical manifestations and signs (characteristics), too, we find great variety, while the differences are too deep-seated to be capable of explanation in terms of divergencies in the localization and extent of the lesions. Some authors have come to the conclusion that duodenal and gastric ulcers are two independent diseases (Frankel and Kark, 1965; Shay and Sun, 1964; Wilson, 1962). Although this idea is unlikely to meet with general acceptance, differences in the incidence of some signs, especially the genetically conditioned, suggest the need for effective grouping of the clinical types of peptic ulcer, because the overall evaluation of the incidence of signs in ulcer conditions as a whole inevitably leads to confused or, indeed, contradictory conclusions, according to which type of ulcer has been prevalent in a given set. The customary use of topical classification is not, however, suitable, since it fails to take into account the dynamics of the condition, which may progressively affect various sections of the alimentary system, and apparently does not even respect certain aetiological factors. Probably for no other disease have so many versions and theories of origin been advanced as for peptic ulcer. This is because the separate factors and conditions, which are undoubtedly important, but not in all cases essential links in the complicated pathogenetic process, have been elevated to the status of sole causes of ulcer formation. A more thorough insight into the nature of the disease and a more exact distinction of individual types of ulcer is of vital significance for effective treatment and prevention. The present work is directed to this end.