Education And Debate

Controversies in Management: Helicobacter pylori is not the causative agent

BMJ 1994; 309 doi: (Published 10 December 1994) Cite this as: BMJ 1994;309:1571
  1. C O Record, consultant physician in gastroenterologya
  1. a Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP

    A pathogenic role for helicobacter in the stomach has been proposed for the past 10 years, but despite about a thousand publications a year on this subject, treatment to eradicate helicobacter remains controversial. Several questions need to be considered.

    Does Helicobacter pylori cause peptic ulcers?

    In the 19th century there was much controversy concerning the role of micro-organisms and the causation of disease. These discussions resulted in the formulation of Koch's postulates. The first is that the infectious agent occurs in every case of the disease and under circumstances that can account for the pathological changes and clinical course of the disease.

    About 95% of patients with symptomatic duodenal ulcer are colonised with H pylori, 50% of those with perforated duodenal, and 17% of those with bleeding duodenal ulcers.1 2 3 About 77% of patients with gastric ulcer are colonised.4 Thus not all patients are infected while those with the severest disease resulting in complications exhibit a lower colonisation rate than patients presenting with uncomplicated dyspepsia.

    By extension of this first postulate the organism should not occur in other disease as a fortuitous and non-pathogenic parasite. Epidemiological studies in Europe have shown about 33% of normal adults are colonised with H pylori.5 In …

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