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Usually ulcers involve the stomach or small intestine (duodenum) and can heal without surgery. The only conditions warranting surgery are severe gastrointestinal hemorrhage, or perforation of the ulcer with the spillage of stomach contents into the abdominal cavity. Also, the prolonged scarring of chronic ulcer disease can produce obstruction in the region of the stomach outlet (pylorus) or duodenum. When this occurs and prolonged vomiting ensues, the only recourse is to surgically bypass the obstruction and again provide a basis for adequate nutrition.

A fourth indication listed in many textbooks is intractability, meaning that the ulcer just won’t heal and therefore surgery is necessary. In my opinion, this usually implies that the patient is “intractable.” Often a refusal to quit smoking, eliminate coffee or alcohol, or change behavior patterns to a more peaceful, low stress mode lies at the root of the nonhealing ulcer.

In my medical and surgical experience, the best results in most types of ulcers are seen when the minimal amount of surgery is performed. Usually this means a selective vagotomy, in which the small nerves that influence only the acid forming portion of the stomach are cut. When necessary, an operation to enlarge the pylorus or to bypass scarring is done. As all surgeons know, tampering with normal stomach physiology in this manner is not without hazard. Iron deficiency anemia, the dumping syndrome (in which the ingestion of simple carbohydrates results in immediate diarrhea), abdominal cramps, and various types of malabsorption can occur.

For the typical ulcer patient whose pain occurs shortly after eating or is aggravated by stress or harmful beverages, the remedy is logical. Eliminate the offending substances—including spices, vinegar, tea, coffee, tobacco, alcohol, and fried foods. The recommended diet, although not entirely “bland,” allows considerable variety of food intake. If these foods are thoroughly masticated good results can be seen.

Avocado is an excellent source of dietary fat to inhibit gastric secretion. With adequate intake of soft fruits, olives, or creamed foods, prompt relief of pain, as well as neutralization of the acid can occur. The intake of baking soda and use of aluminum containing antacids is discouraged, not only because of the cost, but also side effects elsewhere in the body. Hot packs over the abdomen and an abundance of cool water or diluted vegetable juices (carrot, cabbage, etc.) are also helpful in healing these common peptic conditions.

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