Editorial
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World J Gastroenterol. Oct 28, 2006; 12(40): 6413-6419
Published online Oct 28, 2006. doi: 10.3748/wjg.v12.i40.6413
Precise role of H pylori in duodenal ulceration
Michael Hobsley, Frank I Tovey, John Holton
Michael Hobsley, Frank I Tovey, Department of Surgery, Royal Free and University College Medical School, London, United Kingdom
John Holton, Department of Microbiology, Royal Free and University College Medical School, London, United Kingdom
Correspondence to: Michael Hobsley, Fieldside, Barnet Lane, Totteridge, London N20 8AS, United Kingdom. m.hobsley@ucl.ac.uk
Telephone: +44-208-4456507
Received: July 12, 2006
Revised: July 19, 2006
Accepted: July 22, 2006
Published online: October 28, 2006
Abstract

The facts that H pylori infection is commoner in duodenal ulcer (DU) patients than in the normal population, and that eradication results in most cases being cured, have led to the belief that it causes DU. However, early cases of DU are less likely than established ones to be infected. H pylori-negative cases are usually ascribed to specific associated factors such as non-steroidal anti-inflammatory drugs (NSAIDs), Crohn’s disease, and hypergastrinaemia, but even after excluding these, several H pylori-negative cases remain and are particularly common in areas of low prevalence of H pylori infection. Moreover, this incidence of H pylori negative DU is not associated with a fall in overall DU prevalence when compared with countries with a higher H pylori prevalence. In countries with a high H pylori prevalence there are regional differences in DU prevalence, but no evidence of an overall higher prevalence of DU than in countries with a low H pylori prevalence. There is no evidence that virulence factors are predictive of clinical outcome. After healing following eradication of H pylori infection DU can still recur. Medical or surgical measures to reduce acid output can lead to long-term healing despite persistence of H pylori infection. Up to half of cases of acute DU perforation are H pylori negative. These findings lead to the conclusion that H pylori infection does not itself cause DU, but leads to resistance to healing, i.e., chronicity. This conclusion is shown not to be incompatible with the universally high prevalence of DU compared with controls.

Keywords: Duodenal ulceration; H pylori infection; Not causal; Delays healing