Does Helicobacter pylori really cause duodenal ulcers? Yes

doi:10.1136/bmj.b2784

Published 14 August 2009, doi:10.1136/bmj.b2784
Cite this as: BMJ 2009;339:b2784

Head to Head

Does Helicobacter pylori really cause duodenal ulcers? Yes

Alexander C Ford, lecturer in medicine¹, Nicholas J Talley, professor of medicine, visiting professor of medicine²^,3

¹ Department of Academic Medicine, St James’s University Hospital, Leeds LS9 7TF, ² Department of Medicine, Mayo Clinic Florida, Jacksonville, Florida, FL 32224, USA, ³ Department of Medicine, University of Sydney, Nepean Hospital, Sydney, Australia

Correspondence to: A C Ford alexf12399@yahoo.com

The link between duodenal ulcer and Helicobacter pylori hasrevolutionised treatment. Alexander Ford and Nicholas Talleyargue that the association is causal, but Michael Hobsley andcolleagues (doi:10.1136/bmj.b2788) believe acid secretion isthe key

The first 150 words of the full text of this article appear below.

Helicobacter pylori infects the human stomach and is acquiredpredominantly in childhood.¹ Infection is from person to person,and evidence points to transmission through the gastro-oralroute.² Gastric biopsy shows that all infected people have eitherantral or corpus predominant gastritis.³ Which of the two developsprobably depends on the person’s parietal cell mass atthe time of infection.

Although causation can never be proved (hypotheses can onlybe dispelled), evidence for the causative role of H pylori induodenal ulcer is remarkably compelling and fulfils the BradfordHill criteria—for example, showing a strong, consistent,specific, and temporal association (box). The National Institutesof Health judged H pylori to be the main cause of the conditionin 1994. A causal association between H pylori and chronic gastritiswas proposed at the time of its discovery, and Koch’spostulates have since been fulfilled for this histological lesion.⁴

Strength—Odds ratio for . . . [Full text of this article]

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