Recent advances in the pathophysiology of peptic ulcer indicate that 1) a defect in angiogenesis factor is important and that basic fibroblast growth factor leads to rapid ulcer healing, 2) peptic ulcer may be an infectious disease and the addition of 2 weeks of antibiotics to conventional ulcer therapy reduces recurrence from 95percnt; to 12percnt;, and 3) nonsteroidal anti-inflammatory drugs are increasingly more important in precipitating ulcer complications. Proximal gastric vagotomy, the elective treatment of choice for duodenal ulcer, is exceedingly safe but is associated with a 15percnt; ulcer recurrence rate. A new operation, pylorus and anteroseromuscular flap-preserving gastrectomy, is designed to reduce the recurrence rate without increasing complications. Several prospective randomized trials have established that in perforated duodenal ulcer, proximal gastric vagotomy significantly reduces postoperative ulcer recurrence and the need for subsequent operation. With respect to gastric carcinoma, a significant increase in the percentage of early gastric cancers and a significant reduction in operative mortality rates have been reported.
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