Surgery

Over the past few decades, the use of surgery to treat peptic ulcer disease has declined thanks to the widespread use of H2 receptor blockers and proton pump inhibitors, drugs that inhibit acid production in the stomach. Now, the main reason surgery is performed is to treat complications of peptic ulcer disease such as gastrointestinal hemorrhage, perforation, or gastric outlet obstruction.

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In the absence of complications, surgical intervention for gastric ulcers may be considered if there is failure of an ulcer to completely heal after other treatments have been tried and further evaluation is inconclusive. Patients are usually given a six-month trial of drugs to stop acid secretion and eradicate H. pylori prior to surgical consultation. The major concern regarding nonhealed ulcers is the high risk of underlying malignancies.

Because of the benign nature of duodenal ulcers, physicians can monitor the patients' response to medications by following their symptoms. When patients with duodenal ulcers require surgery, it is usually one of three procedures: vagotomy (cutting of the vagus nerve to reduce acid production), vagotomy with antrectomy (removal of the narrow portion of the stomach leading to the duodenum), or subtotal gastrectomy (removal of a portion of the stomach).