Helicobacter pylori, causation, change in natural history, and why Helicobacter-positive duodenal ulcers should not be routinely treated.
The relationship between Helicobacter pylori and duodenal ulcer is reviewed with regard to the following epidemiologic issues: causation, change in natural history, and whether there is sufficient evidence to treat H. pylori-positive peptic ulcers routinely. There is mounting evidence for a pivotal role of H. pylori as a precipitating cause of duodenal ulcers. There is insufficient data to conclude that eradication of H. pylori alone will cure peptic ulcer disease--that is, preventing instead of controlling relapse. H. pylori-positive duodenal ulcers should not be routinely treated because eradication rates need to be improved, metronidazole resistance is an increasing problem, and side-effects of currently used triple combination treatments are substantial.
Veldhuyzen van Zanten
S J
SJ
Division of Gastroenterology, Dalhousie University, Victoria General Hospital, Halifax, Canada.
D004381:Duodenal Ulcer / Q000188:drug therapy* / Q000382:microbiology*; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors