Frozen Ulcers

Most of the nation's 2,500,000 peptic ulcer victims get a measure of relief from bland diets and from tablets and emulsions that neutralize excess stomach acid. But there are tens of thousands who have been forced to submit to more drastic treatment and have had part of their stomachs cut out. In the future, such radical operations may not be necessary. Dr. Owen H. Wangensteen and his inventive research team at the University of Minnesota Hospitals have devised a method of avoiding operations (gastrectomies) simply by giving the stomach a short, quick dose of deep freezing.

Though Dr. Wangensteen pioneered in gastrectomies, did hundreds in 35 years, he was never fully satisfied with the results. Too many patients had such severe and persistent discomfort that though they kept on taking antacids freely, they still did not get enough relief. They were forced to eat little and often. But while treating patients for bleeding stomach ulcers. Surgeon Wangensteen and his research team got an idea. Chilling the stomach checked both the flow of digestive juices and bleeding. Why not deepen the chilling to the freezing stage, knock out the stomach's acid factory more completely, and give the patient relief for months or years? The technique should then be a boon to the almost 90% of peptic ulcer cases whose ulcers are in the duodenum (the next lower unit of the digestive tract): cutting down the flow of corrosive juices at their source in the stomach itself would keep them from eating into any part of the lower intestinal wall.

Rock-Hard. After tests on 150 dogs, the Minneapolis doctors were ready to try the technique in man. Now, one of Dr. Wangensteen's ulcer patients, who has had no food for 15 hours to make sure that his stomach is empty, sits in a chair and gets a local anesthetic sprayed into his throat. He then feels little discomfort as the surgeon shoves a rubber balloon down his throat, through his gullet and into his stomach. Cold absolute alcohol drips into the balloon through attached tubing until the patient feels his stomach distended, as though after a heavy meal. Then he lies on a table and pumping begins.

The tubing--which is actually one tube inside another--permits the frigid liquid (-4DEGF.) to be pumped in and out, constantly recooled and recirculated, until the stomach is frozen to rocklike hardness. But most patients, though fully conscious, feel no discomfort. "Strangely,'' a Wangensteen team member told the American Surgical Association last week, "no patient has complained of the cold tube in his mouth or throat. Nor has any evidence of frostbite of the tongue been observed."

The alcohol coolant is run through the balloon for an hour. Then, after five minutes for thawing, the balloon is pulled out. The patient can get up at once and leave the hospital or clinic. Within two hours he can eat a hearty meal.

No Message. For a year, Wangensteen and his assistants have done no gastrectomies on patients with severe but uncomplicated duodenal ulcers. * All 31 patients who went to the hospital expecting to be cut open gladly chose the proffered alternative of freezing, and are happy they did. Though their output of gastric juices has been drastically reduced, they suffer no indigestion. And all their ulcers healed within two to six weeks. The freezing achieves its effect not only by knocking out the fluid-producing cells in the stomach wall, but also by killing the network of vagal nerve endings that carry messages of hunger to the stomach. So, the Minneapolis team believes, freezing should rule out the need for most vagotomies (nerve-cutting operations), which have been done for the same purpose as gastrectomies and often combined with them.

If the stomach regains too much of its acid-producing power, as it may in a few months, patients may have their stomachs quick-frozen again. And. insists Dr. Wangensteen. most of them could walk in off the street, get the treatment as outpatients, and go back to work.

* In some complicated cases and--ironically--in many more where the ulcer is in the stomach itself, operations are still preferable to freezing.

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