Does Helicobacter pylori really cause duodenal ulcers? No

doi:10.1136/bmj.b2788

Published 14 August 2009, doi:10.1136/bmj.b2788
Cite this as: BMJ 2009;339:b2788

Head to Head

Does Helicobacter pylori really cause duodenal ulcers? No

Michael Hobsley, emeritus professor of surgery¹, Frank I Tovey, honorary senior research associate¹, Karna Dev Bardhan, consultant physician and gastroenterologist ², John Holton, reader in clinical microbiology³

¹ University College London Medical School, London N20 8AS , ² Rotherham General Hospital, Rotherham, ³ Windeyer Institute for Medical Sciences, University College London

Correspondence to: M Hobsley m.hobsley@ucl.ac.uk

The link between duodenal ulcer and Helicobacter pylori hasrevolutionised treatment. Alexander Ford and Nicholas Talley(doi:10.1136/bmj.b2784) argue that the association is causal,but Michael Hobsley and colleagues believe acid secretion isthe key

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

Helicobacter pylori and duodenal ulcer are linked. However,association does not prove causation. An association betweenA and B may mean that A causes B, B causes A, or both B andA are caused by another factor.

Without detracting from the Nobel prize winning investigationthat first drew attention to the role of H pylori, we thinkthat H pylori infection does not cause duodenal ulcer but preventshealing of an ulcer produced by hypersecretion of gastric acid.Acid diminishing treatment reduces the principal barrier againstgastric H pylori infection and so the patient becomes infected.

If H pylori were the primary cause, we would not see regionalvariation in the prevalence of duodenal ulcer within areas ofhigh prevalence, particularly developing countries.¹ ² ³ ⁴ ⁵This does not refer to Holcombe’s "African enigma,"⁶ thealleged finding that duodenal ulcer was uncommon in Africa despitenear ubiquity of the organism; that . . . [Full text of this article]