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Gastric secretions contain hydrogen ions at a concentration that is
more than one million times higher than their intracellular
concentration. This phenomenal gradient as well as the demonstrated
ability of gastric juice to digest tissues has motivated clinicians
and investigators alike to emphasize acid secretion and acid
ablation in studying the pathogenesis and therapy of peptic ulcer
disease. Conse quently, over the past 150 years, we have made
considerable progress in under standing the mechanisms and
regulation of acid secretion by the stomach. Not surprisingly,
therapy for both peptic disease and mucosal injury has also been
predominantly directed at either neutralizing acid or suppressing
its production. During the past 10 years, attention has been
focused on factors other than acid in the genesis and therapy of
ulcer disease. Work done worldwide demon strated that acid
hypersecretion is not a common event in peptic ulcer disease.
Therefore, we began realizing that factors other than acid
secretion may be important in the genesis of ulcer disease or in
gastroduodenal mucosal damage. In addition, new physiological
information has established that the gas troduodenal mucosa is
normally protected by a complex series of events includ ing mucus
and bicarbonate secretion, cell renewal, surface mucosal
restitution, and preservation of the microvasculature and mucosal
proliferative zone.
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