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Donovan C. Browne, M.D.; Robert E. Mitchell Jr., M.D.; Gordon McHardy, M.D.; George E. Welch, M.D.
JAMA. 1954;155(9):807-810. doi:10.1001/jama.1954.03690270003002.
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The controversial opinions prevalent today regarding management of peptic ulcers are understandable, in view of the fact that no single specific causative factor can be established. Probably the most difficult problem confronting the gastroenterologist is selection of the surgical case of gastric ulcer. This has become increasingly important with the growing advocacy by some that all patients with gastric ulcers should be operated on because (1) malignant lesion is present or will develop in 8 to 10%, (2) "... morbidity due to benign ulcers is terminated promptly, the results of surgical treatment are excellent,..."1 and (3) the operative fatality rate is low.

The problem would indeed be simplified if the foregoing statement could be unreservedly accepted, but excellent studies that have accumulated through the years seriously question the advisability of following a surgical course categorically. The follow-up studies of Smith, Boles, and Jordan,2 Cain,1 Brown,3 and a


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