Duodenal ulcer disease: what role does Campylobacter pylori play?

Duodenal ulcer is a chronic relapsing condition which only became common early this century. Many pathogenic factors have been identified including excess gastric acid secretion, cigarette smoking, non-steroidal anti-inflammatory drugs and reduced mucosal defence. There is a strong association of duodenal ulceration, gastric Campylobacter pylori and antral (type-B) gastritis. The link between ulceration in the duodenum and C. pylori-associated antral gastritis may lie in the formation of gastric-type epithelium in the duodenum (gastric metaplasia). This metaplastic tissue is susceptible to C. pylori colonization and therefore to the local effects of these bacteria. Several reports suggest that duodenal ulcer relapse is more frequent in patients infected with C. pylori. These data are reviewed and a brief history of duodenal ulcer disease is presented.