Developments in duodenal ulceration.

Fiberoptic endoscopy is now the standard technique for the precise diagnosis of active duodenal ulceration. Most doctors choose to treat acute ulcer patients using a full dose of a histamine H2-receptor antagonist at the time of ulcer relapse, selecting long-term maintenance treatment for those patients with either aggressive ulceration, old age, or serious coincidental medical illnesses. Helicobacter pylori appears to be an important factor in the chronicity of duodenal ulceration, and those patients with difficult or aggressive ulceration may benefit from an attempt to eradicate the organism from the gastric mucosa. Finally, laparoscopic highly selective vagotomy is in the early stages of clinical assessment, but it is unlikely to have a widespread application.