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Education And Debate

Controversies in Management: Eradication largely prevents relapse

BMJ 1994; 309 doi: (Published 10 December 1994) Cite this as: BMJ 1994;309:1570
  1. C J Hawkey, professora
  1. a Division of Gastroenterology, University Hospital, Nottingham NG7 2UH

    Eradication of Helicobacter pylori should be pivotal in managing peptic ulceration

    Like tuberculosis, peptic ulcer was once a disease of unknown cause. Both were managed by empirical or symptomatic treatments which included (for tuberculosis) the wearing of gold, being touched by King Charles II, and use of cough suppressants,1 and (for peptic ulcer) venesection, rhubarb infusions, nutrient enemas, and drugs which suppress acid.2 With recognition of their infectious aetiology and the use of effective antibiotics, both can now be cured.3 4 Not all patients are cured (often because of poor compliance), but those who are cured rarely experience recurrence.

    Reasons for eradicating H pylori

    Deliberate ingestion of H pylori leads to a persistent active antral gastritis,4 which longitudinal studies have shown to increase the risk of duodenal ulcer about 30 times and the risk of gastric ulcer eight times.5 The prevalence of H pylori in patients with symptomatic duodenal ulcer (about 95%) and in patients with gastric ulcer (70-80%) is much higher than in the general population,4 and 37% of asymptomatic Italian blood donors who were positive for H pylori had duodenal …

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