DUODENAL-ULCER TREATMENT - PROGRESS FROM PH TO HP

The treatment of duodenal ulcer has evolved from ineffective medical t reatments through an era of surgical management, back to increasingly effective medical treatment. The advent of H2-receptor antagonists cha nged the outlook for ulcer patients. More recently, Helicobacter pylor i, an organism which inhabits gastric mucosa exclusively, has been imp licated in the pathogenesis of peptic ulcer. This bacterium is found i n the stomachs of around 95% of duodenal ulcer patients. Its eradicati on is shown dramatically to improve the rate at which ulcers relapse. The mechanisms whereby it may cause ulceration are not established-we review current hypotheses. No method of eradication is 100% effective, and many different dual or triple therapy regimens have been tried. M etronidazole resistance is reported but its importance is not yet know n. Helicobacter eradication is likely to prove a cost-effective and ac ceptable treatment for duodenal ulcer, and once its value has gained a cceptance widespread uptake of this option is anticipated.