Peptic Ulcer and Helicobacter pylori, How to Diagnose and Treat Them

Summary

The diagnosis of peptic ulcer must be precise and based on both endoscopic examination (in the case of gastriculcer to differentiate between benign or malign ulcers), and on bioptic examination. Peptic ulcer is pathogeneticallyassociated with H. pylori. A small group of patients with duodenal ulcers and without H. pylori or without an otherknown cause (NSAID, etc.) is a poorly defined sub-group of patients. H. pylori has an important role in thepathogenesis of gastritis and bulbitis. Both states are involved in the pathogenesis of peptic ulcer. If H. pylori iseradicated, inflammatory changes of the gastric and duodenal mucosa recede and the recurrence of peptic ulcerdecreases to a minimal size. For estimation of H. pylori, several invasive and non-invasive techniques are used.Among invasive methods most used in peptic ulcers, a combination of the rapid urease test and histology seems tobe the most important. Among non-invasive methods, the breath tests are the most reliable. The treatment is focusedon the eradication of H. pylori (no H. pylori is found one month or more after completed therapy). Of the eradicationregimens, the triple therapy with proton pump inhibitors, claritromycin and metronidazole or amoxicilin are mosteffective. If this therapy fails, quadrutherapy (triple therapy combined with colloid bismuth subcitrate) may besuccessful. The precise diagnosis of peptic ulcer and H. pylori infection is a basic prerequisite for rational therapyof peptic ulcer disease and its relapses.

Key words:
peptic ulcer, Helicobacter pylori, diagnosis, therapy.