A new look at peptic ulcer.

There have been notable advances in knowledge about peptic ulcer recently. Gastrin-producing tumors have been recognized as a rare cause of ulcer, and multiple physiologic defects have been found in duodenal ulcer, including excessive release of gastrin after food intake, increased sensitivity to gastrin, and decreased inhibition by low pH. The tendency of gastric ulcer patients to reflux duodenal contents into the stomach may have pathogenetic significance. Two new classes of drugs strongly inhibit acid secretion in man: chemically modified prostaglandins and histamine analogues which block the action of histamine on acid secretion. Their value in treating ulcer is now being assessed in clinical trials. A new operation for duodenal ulcer shows promise: only those vagal fibers innervating the acid-secreting part of the stomach are severed, thus obviating the need for a drainage procedure and decreasing some of the undersirable side effects of earlier operations.