PEPTIC-ULCER DISEASE AND HELICOBACTER-PYLORI INFECTION

The most significant epidemiologic findings over this review period ha ve been the isolation of Helicobacter pylori from feces and the result s of the Eurogast Study firmly linking colonization by H. pylori to th e development of gastric carcinoma. With respect to the mechanisms of pathogenesis, the purification of the cytotoxin and an investigation o f its mode of action are also important. Similarly, the demonstration of the effect of H. pylori on somatostatin and gastrin-releasing pepti de levels open further avenues of research. Numerous serologic tests a re currently available, and an increasing use in screening procedures to reduce endoscopy workloads can be anticipated. The current regimen giving the highest eradication rate is bismuth, metronidazole, and tet racycline for 2 weeks, although the use of omeprazole with antibiotics is becoming more prevalent. Finally, the development of a vaccine is likely to be a major research area for the future.