Peptic ulcer--current status.

Important problems currently under study or requiring investigation for better understanding of the pathophysiology and management are reviewed under three major categories: acute peptic erosions and ulcers, gastric ulcer, and duodenal ulcer. In patients with acute erosions and ulcers, we need to identify patients at risk for major bleeds, to prevent lesions induced by anti-inflammatory, non-steroidal drugs, as well as bleeding from stress ulcers, and to perfect and establish the efficacy of endoscopic methods for coagulation of bleeding ulcers. In patients with gastric ulcers, we need to establish the relative importance of gastric acidity and mucosal resistance to ulcerogenesis, to determine factors that influence healing rates, and to uncover the factors responsible for recurrence. In duodenal ulcer patients, we need to determine the relative importance of post-prandial versus interdigestive secretion, the role of pepsin, and the importance of local defense mechanisms such as bicarbonate and mucus secretion, cellular defense, and blood flow. The mechanisms of failure to heal during treatment need attention. The relation of symptoms and clinical course to healing of ulcer craters should continue to be considered, as well as the long-term course of ulcer disease. The consequences of long-term suppression of acid secretion are a potential hazard, and, finally, the prevention of recurrence remains the major clinical problem in duodenal ulcer.