Is <i>Helicobacter pylori</i> the primary cause of duodenal ulceration?

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<jats:title>Abstract</jats:title><jats:p> <jats:italic>Helicobacter pylori</jats:italic> infection may not be the primary cause of duodenal ulceration in cases not associated with non‐steroidal anti‐inflammatory drugs, but may be a secondary complication. In developing countries with a uniformly high prevalence of <jats:italic>H. pylori</jats:italic> infection there are marked regional differences in the prevalence of duodenal ulcer (DU). In some countries, especially those with a low prevalence of <jats:italic>H. pylori</jats:italic>, 30–40% or more patients with DU may be <jats:italic>H. pylori</jats:italic> negative. The absence of <jats:italic>H. pylori</jats:italic> infection in early cases of DU is also reported. In DU patients with antral <jats:italic>H. pylori</jats:italic> infection, duodenal colonization by <jats:italic>H. pylori</jats:italic> may often be absent. After complete <jats:italic>H. pylori</jats:italic> eradication, recurrence of DU within 6 months in some reports is as high as 20%. The evidence suggests that high acidity and reduced duodenal mucosal resistance remain the primary causes of DU and that <jats:italic>H. pylori</jats:italic> infection, when present, results in chronicity. Reduced mucosal resistance results in duodenal gastric metaplasia which permits colonization of the duodenum with <jats:italic>H. pylori</jats:italic> from the antrum. Therefore, whatever causes reduced mucosal resistance may be the primary factor and evidence suggests that this cause may be diet related. This would explain the enigma of regional variations in DU prevalence unrelated to <jats:italic>H. pylori</jats:italic> prevalence.</jats:p><jats:p>© 1999 Blackwell Science Asia Pty Ltd</jats:p>

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