For most ulcer sufferers, pain is a first warning. Said [Gary Van Deventer] and [John Walsh], ulcer sufferers often complain of pain that comes on at night or between meals. It's not terribly sharp, but seems sort of vague and gnawing. There may be a hunger or burning sensation. The nature of the symptoms, however, presents one of the major problems of ulcer treatment. Ulcer symptoms are identical to those of many other common and far less serious digestive disorders-most notably indigestion commonly brought on by stress.

Since ulcers were first recognized, treating them has had the same goal: lowering the amount of acid in the digestive tract so symptoms are alleviated and the ulcer has a chance to heal. The CURE team emphasized, however, that though a new drug called cimetidine (marketed under the brand name Tagamet) was a major breakthrough in ulcer treatment when it was introduced in the late 1970s, no drug-including cimetidine-actually causes an ulcer to heal. Doctors have found that ulcer pain symptoms usually disappear long before the ulcer has actually healed.

Cimetidine marked a major advance in ulcer therapy because, while it has the same goal as earlier ulcer drugs-inhibiting acid production-cimetidine works better in a wider range of people than such preparations as Maalox, which once dominated ulcer therapy. Surgery to treat ulcer is less common now than it was before cimetidine came along, but Walsh and the rest of the CURE team noted that the surgery rates had begun to decline before cimetidine was introduced, implying that changes in philosophy among internists who specialize in ulcer treatment may be as responsible for the lessening of operations as the introduction of a better drug.