Causes and treatment of peptic ulcer

Summary and Conclusions

1. An attempt is made, by following the ancient classifications, to analyze and evaluate the various causes of peptic ulcer.

2. The material cause—the biological structure of the tissue—may still be considered an uncontrollable factor.

3. The occasional cause — changes in the tissues arising from trauma or circulatory disturbances—are important, but it is doubtful whether they can start an ulcer in the absence of abnormal acidity.

4. The formal cause—the shape of the stomach and the mechanism of the pyloric sphincter—is treated by various types of surgical operations which do not obtain an absolute percentage of good results because they act only indirectly on the efficient cause (secretion of acid) and do nothing for the main or final cause.

5. The efficient cause — hyperacidity — is counteracted by our dietetic prescriptions, but the results are often incomplete because this therapy also does not affect the final cause. Attention is called to the “bad timing” of the acid secretion as an essential feature and to the appearance of prolonged acid crises. Emphasis is laid on the neurogenic theory.

6. The final causes are discussed and a possible line of treatment is suggested regarding the regulation of mental activities in such a way as to protect the local mechanism of digestion against the inroads of the central nervous system.