Peptic ulcer disease, Helicobacter pylori, and the surgeon: changing of the guard.

The ability to assign causative roles to Helicobacter pylori and nonsteroidal anti-inflammatory drug use in peptic ulcer disease, and proof that eradication of H. pylori infection results in cure of peptic ulcer disease, are resulting in a reassessment of the indications for surgery and the type of surgery to be performed. With only a few exceptions, surgery is rapidly becoming an outdated approach to the management of peptic ulcer disease. We will soon see the day when surgeons with great technical skill in peptic ulcer disease will be rare, just as it happened when chest surgeons were no longer needed for the management of chronic pulmonary infections.