title: Assessment and treatment of recurrent peptic ulceration.
abstract: From the experience of treating 91 patients with a proven recurrent ulcer we consider that if a proven ulcer is shown to be present and a gastrin-secreting tumour is excluded an appropriate reoperation will almost always produce a successful result (94 per cent). Before subjecting patients to reoperation all attempts must be made to secure a precise diagnosis. The following investigations should be performed: barium meal, panendoscopy of the upper gastrointestinal tract, determination of maximum acid output (with insulin test and gastrin analysis if appropriate), and cholecystography. Before accepting a diagnosis of recurrent ulcer at least 2 of the first 3 tests should be postive. If the primary operation was a resection we advocate vagotomy alone as the second operation, provided there are no local complications such as stenosis, bleeding, or fistula. If the primary operation was a vagotomy and the recurrence is associated with a positive response to the insulin test we advocate revagotomy and antrectomy. If the insulin test is negative we normally repeat the test; if it is still negative then we use antrectomy alone.
mesh_terms: D001466:Barium Sulfate; D002765:Cholecystography; D004724:Endoscopy; D005500:Follow-Up Studies; D005743:Gastrectomy; D005745:Gastric Acidity Determination; D005755:Gastrins / Q000097:blood; D005763:Gastroenterostomy; D006801:Humans; D010437:Peptic Ulcer / Q000175:diagnosis / Q000601:surgery; D011183:Postoperative Complications; D012008:Recurrence; D014628:Vagotomy
chemical_list: D005755:Gastrins; D001466:Barium Sulfate