WITH REGARD to duodenal ulcer, the interest of the internist is usually directed toward research and clinical problems related to the diagnosis and the medical management. Much time and money are spent in the continuing search for better diets, antacids, anticholinergic, and other drugs. During the past 20 years the interest of the surgeon has shifted from an almost purely mechanistic to a physiologic approach to duodenal ulcer. This is reflected in the volume of the reports dealing with the role that acid peptic secretion plays in the pathogenesis. It has become almost standard practice to evaluate operations for ulcer in terms of their impact on acid peptic secretion.
In view of the volume of clinical and basic research dealing with these matters, it is surprising that the progress which has been made in the prevention and the treatment of duodenal ulcer during the past 20 years is so modest.