X-ray irradiation and conservative surgery in the treatment of chronic duodenal ulcer

Summary 1.A description has been given of the effects of X-ray irradiation of the stomach in 28 patients suffering from chronic duodenal ulcer. 2.In 10 patients irradiation was given alone (1500 r gastric tissue dose over three weeks) and a temporary fall of acid and pepsin secretion with relief of symptoms was produced. However, in 5 patients symptoms returned between eight and twenty-five months later. 3.In 16 patients surgical removal of the ulcerated duodenum and the adjacent gastric antrum was performed (antroduodenectomy), followed by irradiation with 2000 r (g.t.d.) over three weeks; in 2 other patients irradiation was given two months before antroduodenectomy. These patients have been followed for periods ranging between three and eleven months; in none have symptoms of recurrent ulceration occurred and complications and untoward after-effects have been minimal. 4.Irradiation produced a fall in acid and pepsin secretion to low levels or zero and histological changes in the mucosa which were clearly demonstrated in serial gastric biopsies. With a dose of 1500 r return to former acid and pepsin levels and histological appearance usually occurred in six to twelve months. With the larger tissue dose (2000 r) a tendency to return was recorded, but it is too early to judge whether return will be to the pre-irradiation state. 5.The changes in the function and appearance of the gastric mucosa were produced with regularity. It is considered that close attention to the details of posture and X-ray dosage is largely responsible for these results. The techniques used have been described. 6.Using these techniques a fall in acid and pepsin secretion can be produced in a patient with gastric hypersecretion in the absence of any medication and without serious interruption of his work. In the present series radiation sickness was minimal. 7.In conjunction with the operation of antroduodenectomy irradiation has produced satisfactory relief of symptoms in cases of severe chronic duodenal ulcer. However, our experience is limited with regard to numbers of cases and time of follow-up.