Helicobacter Pylori Infection in Peptic Ulcer Disease

Abstract

1.1 Background Helicobacter pylori infection is one of the most common bacterial infections worldwide.1,2 Nearly 50% of the world’s population is affected.3 Though the prevalence of this infection appears to be decreasing in many parts of the world, H. pylori remains an important factor linked to the development of peptic ulcer disease, gastric malignancy and dyspeptic symptoms.4 Majority of H. pylori infected persons remain asymptomatic. Approximately 1015% of the infected persons develop associated illnesses, 1 to 10% developing peptic ulcer disease, 0.1 to 3% developing gastric cancer and less than 0.01% developing gastric mucosaassociated lymphoid tissue (MALT) lymphoma. There are several lines of evidence implicating H. Pylori in the development of gastric and duodenal ulcers. 1. H. Pylori is found in most patients who have peptic ulcers in absence of NSAID use. 2. Presence of H. Pylori is a risk factor for the development of ulcer. 3. Eradication of H. Pylori significantly reduces the recurrence of gastric and duodenal ulcers. 4. Treatment of H. Pylori infection leads to more rapid and reliable ulcer healing than does treatment with anti-secretory therapy alone.15,21 Early studies have estimated the rate of H. Pylori infection in patients with duodenal ulcer to be as high as 90% and in gastric ulcer to be as high as 70 to 90%.5,6,7,29 Despite the decreasing prevalence of H. Pylori infection in developed countries, it is still an important factor in the aetiology of non-iatrogenic peptic ulcer disease. Up to 80% of duodenal ulcers and 70% of gastric ulcers are associated with H. Pylori infection. Several studies have shown that a preexisting H. Pylori infection increases the risk for developing peptic ulcer disease.8,9,10,11 In one study, 11% of patients with H. Pylori gastritis developed peptic ulcer disease compared to 1% of persons without gastritis.10 Eradication of H. Pylori infection significantly reduces the recurrence of gastric and duodenal ulcers.12,13,14,21 One study reviewed the relationship between H. Pylori eradication and reduced recurrence of duodenal and gastric ulcers. Ulcer recurrence was significantly less common among H. Pylori cured patients versus non-cured patients (6% versus 67% for patients with duodenal ulcers; 4% versus 59% for patients with gastric ulcers).12