Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android


Key Points

  • image Whenever testing suggests Helicobacter pylori infection, treatment should be initiated and eradication confirmed.

  • image Lifelong acid suppression should be considered in any patient admitted to a hospital because of peptic ulcer disease. Acid suppressive medication may be equivalent to surgical vagotomy in preventing recurrent peptic ulcer or ulcer complications.

  • image If possible, gastric resection for peptic ulcer is avoided in the asthenic or high-risk patient.

  • image Though less common in the United States, gastric cancer is a major cause of cancer-related morbidity and mortality worldwide.

  • image Diagnostic laparoscopy with peritoneal lavage should be considered in the evaluation of clinical stage 2 and 3 patients with gastric cancer.

  • image Multimodality therapy for gastric cancer, including resection in combination with perioperative chemotherapy or adjuvant chemoradiotherapy is associated with a survival advantage compared to surgery alone.

  • image Most patients with primary gastric lymphoma can be treated without gastric resection.

  • image Localized gastrointestinal stromal tumors of the stomach are treated with full thickness excision. Adjuvant (or neoadjuvant) imatinib is indicated for higher-risk lesions.

  • image Gastric neuroendocrine tumors may arise in the presence (types 1 and 2) or absence (type 3) of hypergastrinemia. Type 3 gastric neuroendocrine tumors should usually be treated with subtotal gastrectomy and regional lymphadenectomy.

  • image Roux-en-Y gastrojejunostomy with a large (>50%) proximal gastric remnant should be avoided because marginal ulceration and/or gastric stasis (Roux syndrome) may become problematic.


The stomach stores and facilitates the digestion and absorption of ingested food and helps regulate appetite. Treatable diseases of the stomach are common, and it is accessible and relatively forgiving of surgical manipulation. To provide accurate diagnosis and rational treatment, the physician must understand gastric anatomy, physiology, and pathophysiology; this includes a sound understanding of the mechanical, secretory, and endocrine processes by which the stomach accomplishes its important functions and a familiarity with the common benign and malignant gastric disorders. Important historical milestones1–6 that influenced the contemporary understanding of gastric disease and surgical therapy are summarized in Table 26-1.

Table 26-1Historic milestones in gastric surgery

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.