IS THE AGGRESSIVE MANAGEMENT OF PEPTIC-ULCER JUSTIFIED BY THE DATA

Sophisticated and very effective means of diagnosing and treating pept ic ulcers are now available. This entails considerable resource utiliz ation in affluent western societies, all with resource limitations, wh ich mean that the costs need to be balanced by the outcomes achieved-t he benefits. Little attention has been paid to the risk to life and we ll-being posed by ulcer and the effect, if any, of the intervention on such risks. I present an analysis of the natural history of peptic ul cer including studies incorporating life-table analysis and a populati on comparison. The conclusions are clear. The possessors of a peptic u lcer have, in general, a normal life expectancy. A major cause of ulce r-related death in the past was postoperative. Symptoms and workloss h ave diminished after the introduction of H-2 antagonists, but no evide nce is yet available of any change in the rates of bleeding, perforati on or death from ulcer related to modem methods of diagnosis and manag ement. The risk of major complication is approximately 0.025/year over the next 1 0 years. The risk of death is greatest in elderly women wi th gastric ulcer and in those on corticosteroids. The data suggest to me that the costs of aggressive investigation and treatment of peptic ulcer need to be justified by the dangers averted.