In numerous experiments, it has been shown that back diffusion of hydrogen ion across the abnormally permeable gastric mucosa causes damage. This type of situation may exist in patients with gastric ulcers, and these experiments have been considered as models for studying the etiology of gastric ulcer disease. Using dogs with Heidenhain pouches and gastric fistulas, the current experiments demonstrate that when the gastric mucosa is damaged by high concentrations of hydrochloric acid, pepsin output increases. Pepsin output was directly related to the back diffusion of hydrogen, suggesting that pepsin output may be increased in the abnormally permeable mucosa and may be of etiologic importance in ulcer disease.