Ulcers and gastritis

Once again this year, developments in the field of ulcers and gastritis hav e been entirely dominated by findings relating to Helicobacter pylori . How ever, interest in H, pylori can be expected to decline, since the prevalenc e of the infection is rapidly decreasing in the developing world - to the p oint that many gastroduodenal ulcers are now unrelated to H. pylori A furth er reason for declining interest is disappointment regarding the role of H. pylori in dyspepsia, The expected reduction in the endoscopic workload pro duced by screening for H Pylori or cagA positivity has so far not occurred, The exact role of the damage caused by nonsteroidal anti-inflammatory drug s in H. pylori-infected stomachs remains controversial. Equally controversi al is the magnitude of the increased reflux symptomatology and reflux disea se observed after H. pylori infection has been cured in patients with ulcer disease. Eradication therapy is largely dominated by proton-pump inhibitor triple therapies, although the efficacy of these is declining. Bismuth tri ple therapy and quadruple therapy continue to be valid alternatives.