Acid reduction by medical or surgical treatment for duodenal ulcer

Despite the reduction in elective surgery for peptic ulcer over the past 2 decades, the morbidity and mortality from the complications of duodenal ulceration have failed to improve. The principle line of treatment is gastric acid reduction by pharmacological or surgical means. The three ways of dealing with the naturally relapsing disease are intermittent treatment of symptomatic recurrences, continuous maintenance therapy or surgery. Surgical methods of acid reduction lead to greatly improved relapse rates when compared with H2-receptor antagonist therapy, probably due to the continuous acid suppression throughout the day, but at the expense of a measurable morbidity and mortality, and are thus not appropriate for the majority of ulcer patients. The long-term safety of profound acid suppression has been the subject of considerable debate but is of questionable clinical significance. Omeprazole is likely to be as effective as surgery and its full impact on the natural history of duodenal ulcer disease has yet to be assessed.