Ulcer: The Primary Cause of Gastric and Duodenal Ulcer: Diagnosis, Medical and Surgical Treatment, Prevention

JAMA. 1948;137(15):1345. doi:10.1001/jama.1948.02890490073038.
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The author has written in an interesting manner the medical facts and theories surrounding the most widely discussed topic—peptic ulcer. He mentions all the common theories of ulcer causation and notes the factors that are not explained in each of these theories. Then he speaks of the "primary cause" of ulcer, whether gastric or duodenal, which is his contribution to the subject. It is based on ischemia and anemia of the stomach mucosa and wall, due to pressure against the stomach by the posterior wall of the liver and behind by the spinal vertebral bodies, the crura of the diaphragm and the firm prevertebral tissue. He pays especial attention to the length of time the ulcer-bearing area of the stomach is held in the angle of the hepatovertebral notch and the severity of the pressure and the anemia which results. This lowering of tissue resistance predisposes to ulcer formation. He


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