We investigated the role of gastric mucosal proliferation and mucosal transforming growth factor-alpha (TGF alpha) in the healing of peptic ulcers in human subjects. During endoscopic observation, mucosal biopsy specimens were taken from the ulcer margin for flow cytometric analysis of the mucosal cell cycle and ELISA for mucosal TGF alpha content. Immunohistochemistry confirmed that biopsy specimens contained proliferating gastric epithelial cells, TGF alpha, and the TGF alpha receptor. When the stage of ulcer healing was categorized according to Sakita and Miwa, mucosal cell proliferation was less at active stages and gradually increased during the healing process. The mucosal TGF alpha level at the ulcer margin was not detectable at the A1 stage but increased to within the normal range during ulcer healing. After re-establishment of the epithelial layer at the site of the ulcer, cell proliferation returned to normal and TGF alpha remained within the normal range. Immunohistochemistry showed coexistence of TGF alpha and its receptor within PCNA-positive proliferating cells. These results suggest that TGF alpha and its receptor play an important role in gastric epithelial cell replication. The increase in TGF alpha at the ulcer margin might indicate a role in stimulation of gastric cell replication during ulcer healing.