Recent advances in the treatment of duodenal ulcer disease. A surgical perspective.

Chronic peptic ulceration is a disease process in transition. During the past two decades, the disease has changed in its incidence, in its presentation and in its medical consequences. The pathogenesis of acid-peptic disease has been the major focus of numerous investigations, and major advances in understanding basic gastric physiology have led to specific and increasingly effective therapeutic approaches. With the introduction of H(2)-receptor antagonists, the treatment of peptic ulceration has been radically altered, and many new therapies await clinical trial. Surgeons treating gastroduodenal ulceration will require greater knowledge of gastric physiology and an increasingly refined appreciation of both the power and limitations of various medical and surgical therapies.