Towards a rational treatment of duodenal ulcer.

This review concerns itself with the current understanding of the control of gastric secretion and the application of this knowledge to the design of treatment for duodenal ulcer through the reduction of acid and pepsin load on the duodenal bulb. The control of gastric secretion is described under the headings: (i) neurohormonal; (ii) endocrine; (iii) paracrine; (iv) luminal; and (v) cellular. This discussion is followed by a description of the pathophysiology of gastric secretion in duodenal ulceration. The strategies of treatment are discussed under four headings: (i) postsecretory treatments; (ii) destruction of the gastric mucosa; (iii) alteration of neurohormonal controls; and (iv) modification or inhibition of the cellular mechanisms of acid and pepsin secretion. Several currently useful and potentially important new lines of treatment are described.