Peptic Ulcer Disease

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Abstract
The availability of duodenoscopy and methods to assay serum gastrin have added new dimensions to our clinical assessment of peptic ulcer disease. We are learning more about parietal cells, G-cells, pyloric sphincters, and gastrin, and about the pathogenesis of ulcers, how to differentiate simple ulcers from those associated with gastrinomas, and how to choose a rational approach to therapy. H2-receptor blockers and prostaglandins, both strong inhibitors of gastric acid secretion, are on the therapeutic horizon. The incidence of recurrent ulcerations can now be surgically reduced by subselective vagotomy of the fundic gland area, which selectively denervates parietal cell mass without interfering with gastric emptying.—AR