IsHelicobacter pyloriInfection the Primary Cause of Duodenal Ulceration or a Secondary Factor? A Review of the Evidence

Abstract

Helicobacter pylori(H. pylori) has a role in the multifactorial etiology of peptic ulcer disease. A link betweenH. pyloriinfection and duodenal ulcer disease is now established. Other contributing factors and their interaction with the organism may initiate the ulcerative process. The fact that eradication ofH. pyloriinfection leads to a long-term cure in the majority of duodenal ulcer patients and the fact that the prevalence of infection is higher in ulcer patients than in the normal population are cogent arguments in favor of it being the primary cause of the ulceration. Against this concept there are issues that need explanation such as the reason why only a minority of infected persons develop duodenal ulceration when infection withH. pyloriis widespread. There is evidence thatH. pyloriinfection has been prevalent for several centuries, yet duodenal ulceration became common at the beginning of the twentieth century. The prevalence of duodenal ulceration is not higher in countries with a high prevalence ofH. pyloriinfection. This paper debate puts forth the point of view of two groups of workers in this field whetherH. pyloriinfection is the primary cause of duodenal ulcer disease or a secondary factor.