Reassessment of the Management of Benign Gastric Ulcer with Achlorhydria

Previous reports of benign gastric ulcer with achlorhydria have recommended surgical removal of the ulcer, even though a malignant process had not been demonstrated. We report a patient with achlorhydria and a gastric ulcer who, at exploration 4 weeks after discovery, had only a healed ulcer. Its benign nature was demonstrated by endoscopic biopsies and cytology and confirmed at surgery. The patient has remained achlorhydric on follow-up and has not had further ulcers. We recommend that, after multiple endoscopic biopsies and cytology have adequately excluded a malignant process, a gastric ulcer be followed to complete healing, even in the presence of achlorhydria. If healing is incomplete by 6–12 weeks, surgical intervention should be contemplated, just as for more routine gastric ulcers.