The problem ulcer: bleeding, perforation, Helicobacter pylori-negativity and intractability
Since the discovery of Helicobacter pylori in 1982, this Gram-negative bacterium has been associated with a variety of clinical conditions. The bacterium was initially reported to be present in 80–100% of duodenal ulcer patients. In recent larger studies, with improved diagnostic techniques, the prevalence of H. pylori in uncomplicated duodenal ulcers is reported to be approximately 95%1. Duodenal ulcer disease is usually a chronic recurrent condition in untreated individuals. In excess of 50% of patients have dyspeptic symptoms for more than 2 years before presentation. In the pre-H. pylori era, of patients who were followed for 1 year after ulcer healing, 57% had one or two recurrences, 7% had more than three recurrences and 36% remained symptom-free2. Overall 50–80% of duodenal ulcer patients will have a recurrence during a 12-month follow-up after healing. Eradication of H. pylori alters the natural history of peptic ulcer disease and virtually abolishes ulcer relapse rates during 1 year follow-up3.
KeywordsPeptic Ulcer Duodenal Ulcer Pylorus Infection Peptic Ulcer Disease Systemic Mastocytosis
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