Is Helicobacter pylori the primary cause of duodenal ulceration?

Helicobacter pylori infection may not be the primary cause of duodenal ulceration in cases not associated with non‐steroidal anti‐inflammatory drugs, but may be a secondary complication. In developing countries with a uniformly high prevalence of H. pylori infection there are marked regional differe...

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Bibliographic Details
Published in:Journal of gastroenterology and hepatology 1999-11, Vol.14 (11), p.1053-1056
Main Authors: Tovey, Frank I, Hobsley, Michael
Format: Article
Language:English
Subjects:
aetiology
Bacterial diseases
Bacterial diseases of the digestive system and abdomen
Biological and medical sciences
Causality
Cross-Sectional Studies
Developing Countries
diet
duodenal ulcer
Duodenal Ulcer - diagnosis
Duodenal Ulcer - epidemiology
Feeding Behavior
Helicobacter Infections - diagnosis
Helicobacter Infections - epidemiology
Helicobacter pylori
Human bacterial diseases
Humans
Infectious diseases
Medical sciences
prevalence
Risk Factors
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Summary:Helicobacter pylori infection may not be the primary cause of duodenal ulceration in cases not associated with non‐steroidal anti‐inflammatory drugs, but may be a secondary complication. In developing countries with a uniformly high prevalence of H. pylori infection there are marked regional differences in the prevalence of duodenal ulcer (DU). In some countries, especially those with a low prevalence of H. pylori, 30–40% or more patients with DU may be H. pylori negative. The absence of H. pylori infection in early cases of DU is also reported. In DU patients with antral H. pylori infection, duodenal colonization by H. pylori may often be absent. After complete H. pylori eradication, recurrence of DU within 6 months in some reports is as high as 20%. The evidence suggests that high acidity and reduced duodenal mucosal resistance remain the primary causes of DU and that H. pylori infection, when present, results in chronicity. Reduced mucosal resistance results in duodenal gastric metaplasia which permits colonization of the duodenum with H. pylori from the antrum. Therefore, whatever causes reduced mucosal resistance may be the primary factor and evidence suggests that this cause may be diet related. This would explain the enigma of regional variations in DU prevalence unrelated to H. pylori prevalence. © 1999 Blackwell Science Asia Pty Ltd
ISSN:0815-9319
1440-1746
DOI:10.1046/j.1440-1746.1999.02005.x