The problem ulcer: bleeding, perforation, Helicobacter pylori-negativity and intractability

  • M. Buckley
  • J. Lee
  • C. O’Morain


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.


Peptic Ulcer Duodenal Ulcer Pylorus Infection Peptic Ulcer Disease Systemic Mastocytosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kuipers EJ, Thijs JC, Festen HMP. The prevalence of Helicobacter pylori in peptic ulcer disease. Aliment Pharmacol Ther. 1995;9(Suppl. 2):59–69.PubMedGoogle Scholar
  2. 2.
    Malmros H, Hiertonn T. A post-investigation of 687 medically treated cases of peptic ulcer. Acta Med Scand. 1949; 133:229.PubMedCrossRefGoogle Scholar
  3. 3.
    Coghlan JD, Gilligan D, Humphries H et al. Campylobacter pylori and recurrence of duodenal ulcers. Lancet. 1987;2:1109–11.PubMedCrossRefGoogle Scholar
  4. 4.
    Goh KL, Parasakthi N, Peh SC et al. Helicobacter pylori eradication with short-term therapy leads to duodenal ulcer healing without the need for continued acid suppressing therapy. Eur J Gastroenterol Hepatol. 1996;8:421–3.PubMedCrossRefGoogle Scholar
  5. 5.
    Buckley M, O’Morain C. Helicobacter pylori eradication — a surrogate marker for duodenal ulcer healing. Eur J Gastroenterol Hepatol. 1996;8:415–16.PubMedGoogle Scholar
  6. 6.
    Fry J. Peptic ulcer: a profile. Br Med J. 1964;2:809.PubMedCrossRefGoogle Scholar
  7. 7.
    Kurath JH, Corboy ED. Current peptic ulcer time trends: an epidemiological profile. J Clin Gastroenterol. 1988;10:259–68.CrossRefGoogle Scholar
  8. 8.
    Makela J, Laitien S, Kairaluoma MI. Complications of peptic ulcer disease before and after the introduction of H2 receptor antagonist. Hepatogastroenterology. 1992;39:144–8.PubMedGoogle Scholar
  9. 9.
    Hoskings W, Young MY, Chung SC, Li AKC. Differing prevalence of Helicobacter pylori in bleeding and non bleeding ulcers. Gastroenterology. 1992; 102: A85.Google Scholar
  10. 10.
    Hodgkin SW, Ling TKW, Young MY et al. Randomised control trial of short term treatment eradicating Helicobacter pylori in patients with duodenal ulcer. Br Med J. 1992;305:502.CrossRefGoogle Scholar
  11. 11.
    Jensen DM, You S, Pelayo E, Jensen ME. The prevalence of Helicobacter pylori and NSAID use in patients with severe UGI haemorrhage and their potential role in recurrence of ulcer bleeding. Gastroenterology. 1992; 102: A85.Google Scholar
  12. 12.
    Kaufman DW, Kelly JP, Sheehan JE et al. Nonsteroidal anti-inflammatory drug use in relation to major upper gastrointestinal bleeding. Clin Pharmacol Ther. 1983;53:485–94.CrossRefGoogle Scholar
  13. 13.
    Somerville K, Faulkner G, Langman M. Non-steroidal anti-inflammatory drugs and bleeding peptic ulcer. Lancet. 1986;1:462–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Hovoet J, Terriere L, van Hee W, Verbist L, Fierens E, Hauteteete ML. Relation of upper gastrointestinal bleeding to non-steroidal anti-inflammatory drugs and aspirin: a case control study. Gut. 1991;32:730–4.CrossRefGoogle Scholar
  15. 15.
    Lai KC, Hui WM, Lam SK. Bleeding ulcers have high false negative rates for antral Helicobacter pylori when tested with urease test. Gastroenterology. 1996; 110: A167.CrossRefGoogle Scholar
  16. 16.
    Jensen DM, Cheng S, Kovacs TOG et al. A control study of ranitidine for the prevention of recurrent haemorrhage from duodenal ulcer. N Engl J Med. 1994;303:382–6.CrossRefGoogle Scholar
  17. 17.
    Laine L, Peterson WL. Bleeding peptic ulcer. N Engl J Med. 1994;331:717–27.PubMedCrossRefGoogle Scholar
  18. 18.
    Murray WR, Cooper G, Laferla G, Rogers P, Archibald M. Maintenance ranitidine treatment after haemorrhage from a duodenal ulcer: A 3 year study. Scand J Gastroenterol. 1988;23:183–7.CrossRefGoogle Scholar
  19. 19.
    Rokkas T, Karameris A, Mavrogeorgis A, Rallis E. Eradication of Helicobacter pylori reduces the possibility of rebleeding in peptic ulcer disease. Gastrointest Endosc. 1995;41:1–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Labenz J, Borsch G. The role of Helicobacter pylori by eradication and the prevention of peptic ulcer bleeding relapse. Indigestion. 1994;55:19–23.CrossRefGoogle Scholar
  21. 21.
    Graham DY, Hepps KS, Ramirez FC, Lew GM, Saeed ZA. Treatment of Helicobacter pylori reduces the rate of rebleeding in peptic ulcer disease. Scand J Gastroenterol. 1993;28:939–42.PubMedCrossRefGoogle Scholar
  22. 22.
    Jaspersen D, Korner T, Schorr W, Brennensthul M, Raschka C, Hammar CH. Helicobacter pylori eradication reduces the rate of rebleeding of an ulcer haemorrhage. Gastrointest Endosc. 1995;41:5–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Jaspersen P, Korner T, Schorr W, Brennersthul M, Raschka C, Hammar CH. Omeprazole, amoxicillin therapy for eradication of Helicobacter pylori in duodenal ulcer bleeding: preliminary results of a pilot study. J Gastroenterol. 1995;30:319–21.PubMedCrossRefGoogle Scholar
  24. 24.
    Debongnie JC, Legross G. Gastric perforation: an acute disease unrelated to H. pylori? Rev Esp Enferm Dig. 1990;78(Suppl. 1):71–2.Google Scholar
  25. 25.
    Turner FP. Acute perforations of the stomach, duodenum and jejunum. Surg Gynaecol Obstet. 1951;92:281.Google Scholar
  26. 26.
    Reinbach DH, Cruickshank G, McColl KEL. Acute perforated duodenal ulcer is not associated with Helicobacter pylori infection. Gut. 1993;34:1344–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Armstrong CP, Blower AL. Non-steroidal anti-inflammatory drugs in life threatening complications of peptic ulceration. Gut. 1987;28:527–32.PubMedCrossRefGoogle Scholar
  28. 28.
    Horowitz J, Kukuora JS, Ritchie WP. All perforated ulcers are not alike. Ann Surg. 1989;209: 693–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Collier D, Sant J, Pain JA. Non-steroidal anti-inflammatory drugs in peptic ulcer perforation. Gut. 1985;26:359–62.PubMedCrossRefGoogle Scholar
  30. 30.
    Oberhuber G, Puspok A, Oesterreicher C et al. Crohn’s disease of the stomach is histologically characterized by focal active gastritis. Gastroenterology. 1996;110:A982.Google Scholar
  31. 31.
    Borody TJ, George LL, Brandl S, Andrews P, Ostapowicz N, Hyland M, Devine M. Helicobacter pylori negative duodenal ulceration. Am J Gastroenterol. 1991;86:1154–7.PubMedGoogle Scholar
  32. 32.
    Nensey YW, Schubert TT, Bolonga SD, Ma CK. Helicobacter pylori negative duodenal ulceration. Am J Med. 1991;91:15–18.PubMedCrossRefGoogle Scholar
  33. 33.
    McColl KEL, El-Nujumi AM, Chittajallu RS et al. A study of the pathogenesis of Helicobacter pylori negative chronic duodenal ulceration. Gut. 1993;34:762–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Black JW, Duncan WAM, Durant CJ, Ganellin CR, Parsons ME. Definition and antagonism of histamine H2 receptors. Nature. 1972,236:385.PubMedCrossRefGoogle Scholar
  35. 35.
    Tytgat GNJ. Treatments that impact favourably upon the eradication of Helicobacter pylori and ulcer recurrence (review). Aliment Pharmacol Ther. 1994;8:359–68.PubMedCrossRefGoogle Scholar
  36. 36.
    Miehlke S, Bayerdorrfer E, Lehn N et al. Recurrence of duodenal ulcers during five years of follow-up after cure of Helicobacter pylori. Eur J Gastroenterol. 1995;7:975–8.CrossRefGoogle Scholar
  37. 37.
    Lanas AI, Remacha B, Esteva F, Sainz R. Risk factors associated with refractory peptic ulcers. Gastroenterology. 1995;109:1124–33.PubMedCrossRefGoogle Scholar
  38. 38.
    Veldhuyzen van Zanten SOJ. H. pylori and NSAIDs: a meta-analysis on interactions of acute gastroduodenal injury, gastric and duodenal ulcers and upper gastrointestinal symptoms. In: Hunt RH, Tytgat GNJ, editors. Helicobacter pylori: basic mechanism to clinical cure. Dordrecht: Kluwer; 1994:449–57.Google Scholar

Copyright information

© Kluwer Academic Publishers and Axcan Pharma 1996

Authors and Affiliations

  • M. Buckley
  • J. Lee
  • C. O’Morain

There are no affiliations available

Personalised recommendations