[Epidemiology, pathophysiology, and therapy of peptic ulcer--recent advances (author's transl)]

Fiberscopy of the upper gastrointestinal tract created a revolution in the diagnosis of peptic ulcer and allows an exact control of ulcer healing. A reinvestigation of the epidemiology of ulcer disease apparently is necessary. In 1000 patients of our department investigated between 1971 and 1977 the percentage of persons more than 60 years old was higher than in earlier publications, more than 50% of gastric and about 24% of duodenal ulcers. Therapeutic measures deplorably are mainly directed towards aggressive factors, gastric acid and pepsine, and our knowledge about protective mechanisms and therapeutic schemes in this field are not sufficient. Only for a small selection of drugs, f.i. carbenoxolone, antacids in high doses, cimetidine, pirenzepin and a few others, a beneficial effect on ulcer healing has been demonstrated in randomized double blind studies. Some combinations might be useful but have not been examined sufficiently yet. Improved conservative treatment competes with advances in surgery of the peptic ulcer. However, in old people with a greater risk for surgery there is often no alternative to medical treatment.