Pyloric-Sphincter Dysfunction and Gastric Ulcer

To the Editor: The paper by Fisher and Cohen, “Pyloric-Sphincter Dysfunction in Patients with Gastric Ulcer” (N Engl J Med 288:273–276, 1973), showing pyloric incompetency in patients with gastric ulcer, both active and healed, raises some interesting questions. Pyloroplasty, which disrupts pyloric-sphincter competency, should increase the incidence of postoperative gastric ulcer. At present, there is no evidence of such an increased susceptibility. In fact the incidence, in view of the large numbers of pyloroplasties performed, seems to be very low. If further studies show an increased incidence, one may question the value of management of duodenal ulcer with pyloroplasty. Does.