THE INFECTIOUS ETIOLOGY OF PEPTIC ULCER DISEASE

During the past decade, the diagnosis and treatment of peptic ulcer disease (PUD) have undergone major changes. Previously considered a disorder primarily of mucosal disruption by gastric acid, PUD now is recognized as multifactorial in etiology, with a major factor thought to be the presence in the stomach of a spiral-shaped bacterium known as Helicobacter pylori (HP). Since 1982 when Marshall and Warren 38 first isolated and cultured this organism, thousands of articles have been written showing associations between HP and most cases of chronic gastritis and gastroduodenal ulceration. 21,38 Etiologic links between the organism and neoplastic processes such as gastric lymphoma and adenocarcinoma also have been suggested. 16,31 This article discusses many aspects of HP infection, its relationship to PUD and other gastrointestinal disorders, methods for detection, and various treatment strategies.