Peptic ulcer--a new look

This review covers major advances in peptic ulcer disease over the last 25 years. Flexible endoscopy enables accurate diagnosis of peptic ulcer to be made and its introduction made possible the large number of controlled clinical trials on the use of various agents in peptic ulcer treatment. The histamine H-2 receptor antagonists, which reduce gastric acid output, were the first major group of potent ulcer healing drugs introduced. Subsequently, other ulcer healing agents with different modes of action, e.g. colloidal bismuth, sucralfate, prostaglandin analogues, omeprazole were also shown to be effective. The identification of Helicobacter pylori ten years ago was another major advance in peptic ulcer disease. This bacterium is now thought to be the most important cause of peptic ulcer disease and its eradication cures the disease. There are still unanswered questions regarding varying sequelae of Helicobacter pylori infection, the effect of the infection on gastric acid and gastrin secretion while a convenient and effective treatment regime remains to be developed. Non-steroidal anti-inflammatory drugs are now thought to be the second most important cause of peptic ulcer disease and a major risk factor for ulcer complications and mortality. While misoprostol and histamine H-2 antagonists can prevent peptic ulcer associated with these substances, indications for prophylaxis have not yet been defined. If Helicobacter pylori infection could be controlled through improved socio-economic standards and possible development of a vaccine, and if anti-inflammatory drugs devoid of gastric side effects can be developed, peptic ulcer may become a less important health problem in the future.