Peptic ulcer disease and Helicobacter pylori infection

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The most significant epidemiologic findings over this review period have been the isolation of Helicobacter pylori from feces and the results of the Eurogast Study firmly linking colonization by H. pylori to the development of gastric carcinoma. With respect to the mechanisms of pathogenesis, the purification of the cytotoxin and an investigation of its mode of action are also important. Similarly, the demonstration of the effect of H. pylori on somatostatin and gastrin-releasing peptide levels open further avenues of research. Numerous serologic tests are currently available, and an increasing use in screening procedures to reduce endoscopy workloads can be anticipated. The current regimen giving the highest eradication rate is bismuth, metronidazole, and tetracycline for 2 weeks, although the use of omeprazole with antibiotics is becoming more prevalent. Finally, the development of a vaccine is likely to be a major research area for the future.

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