The rationale in the treatment of peptic ulcer disease.

1) In chronic gastric ulcer bed rest, leaving out smoking and carbenoxolone have increased the rate of healing. 2) In chronic duodenal ulcer it has yet to be shown that any medical measure so far significantly altered the course of the disease. 3) The surgical approach to the treatment of chronic duodenal ulcer is based upon three principles, all of them aiming at reducing the acid-pepsin secretion: a) Removal of the acid secreting mucosa decreases the acid secretory capacity of the stomach; b) Removal of the pyloric antrum eliminates the main source of gastrin, the major known humoral excitant of acid secretion; c) Section of the vagi probably renders the acid secreting cells less responsive to humoral stimulation (Brooks). The major problem, however, which is the prevention of recurrent duodenal ulcer is yet unsolved. There is some hope that the new receptor blocking agent metiamid is the first step, and there is even more hope in that the proceedings of this symposium will show us further steps forward.