Current aspects of gastroduodenal ulcer disease: diagnosis of pathophysiologic background and indications for operative therapy.

The management of gastroduodenal ulcer disease has changed because of new evidence of its pathophysiologic background and the introduction of new medication and operative techniques. Proximal gastric vagotomy (PGV) was abandoned by some as the treatment of choice because of high recurrence rates. With the advent of minimally invasive surgery, laparoscopic vagotomy has renewed interest in vagotomy as a treatment option for gastroduodenal ulcer disease. In view of this development, a study was performed to investigate the incidence of abnormal gastric hyperacidity in a population of ulcer patients in order to select those patients for operative acid reduction who will benefit most from operation. Sixty-eight patients with gastroduodenal ulcer disease underwent 24-hour-gastric-pH monitoring, 29 of these patients subsequently underwent proximal gastric vagotomy. The study demonstrates that it is possible to identify patients with hyperacidity. It revealed a variation of intraluminal gastric acidity in patients with different ulcer locations. On the basis of the opinion that gastric hyperacidity is the main indication for PGV, it is emphasized that the choice of surgery should depend on the functional defect and that the indication for operation should be based on therapy-resistant symptoms.