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Thorough long-term clinical, endoscopic and biopsy follow-up (from 6 months to greater than 8 years; mean follow-up: 3 years 3 months) of a group of 202 cases of apparently benign gastric ulcer has enabled us to evaluate the natural history of gastric ulcer in relation to medical therapy with H2-blockers and to patient compliance when using such drugs. The results confirm the efficacy of H2-antagonist therapy in gastric ulcer healing and in the prevention of relapse. Thorough follow-up, moreover, made it possible to keep surgical operations for non-neoplastic causes down to very low numbers, only 3 patients (1.5%) being operated on for haemorrhagic emergencies and 12 (6%) for non-response to therapy.

Over the period from January 1980 to March 1988 the frequency of dysplastic abnormalities associated wits 202 apparently benign gastric ulcers was determined and their course monitored. The relevant data were then evaluated separately for the various subgroups the ulcers were divided into on the basis of their natural history. No correlation was detected between natural history of gastric ulcer, dysplasia and onset of cancer. Though all dysplastic forms (mild, moderate and severe) may regress, all three showed a possibility of progression to EGC, obviously in increasing percentages: mild dysplasia: 2.53%; moderate dysplasia: 4.76%; severe dysplasia: 14.29%. The last of these three values appears to indicate a greater risk of cancer onset than in simple gastric ulcer and thus proves a useful marker for a more thorough monitoring of such patients.