Facts and Fallacies of Current Medical Therapy for Uncomplicated Duodenal Ulcer

THE REMARKABLE ADVANCES made in medicine do not include the cause and cure of peptic ulcer. Treatment continues to be dominated by speculation, insufficient awareness of the "spontaneous" remissions and exacerbations, and by excessive reliance upon therapeutic trials in animals and in vitro testing. The presence of ulcer deformities or scars in the stomach and duodenal bulb on routine x-ray examination, at operation or autopsy, in patients without previously suspected peptic ulcer, has encouraged the attitude that, since some ulcers apparently heal without treatment, therapy is unnecessary. While ulcers may heal "spontaneously," peptic ulcer very often is a chronic recurrent disease complicated by stenosis, obstruction, hemorrhage, or perforation; it requires adequate medical management based upon the available knowledge of its pathogenesis and course. Physiologically, peptic ulcer represents the failure of localized areas of the gastroduodenal mucosa to withstand the destructive effects of acid and pepsin in the gastric content. Factors