Peptic ulcer disease – who is to blame and what to do?

The first successes in the treatment of peptic ulcer disease (PU) using antibiotics in combination with proton pump blockers contributed to the emergence of the hypothesis that H. pylori is the main cause of PU. Moreover, it was assumed that eradication of H. pylori could lead to elimination of ulcerative disease. However, 40 years after the discovery of H. pylori, it became clear that eradication therapy reduces the time to ulcer healing, improves the quality of life and prolongs remission, but does not eliminate PU. Nevertheless, the new Maastricht VI guidelines still proclaim H. pylori eradication as the main goal of therapy for H. pylori-associated diseases. The widespread use of antibiotics has saved millions of lives. At the same time, bacterial resistance to existing antibiotics due to the ongoing escalation of antibacterial therapy has been named by the World Health Organization as one of the main threats to humanity in this century. Therefore, the infectious concept of the pathogenesis of PU and the principles of its treatment require clarification.

Key words

Peptic ulcer, risk factors, vascular factor, Helicobacter pylori, eradication therapy.