Duggan John M, Duggan Anne E
Princeton Medical Centre, Newcastle, NSW, Australia.
Med J Aust. 2006;185(11-12):667-9. doi: 10.5694/j.1326-5377.2006.tb00747.x.
Helicobacter pylori is established as a cause of peptic ulcer (PU). Less well recognised is that an epidemic of PU began around the middle of the 19th century, reached a peak at the turn of the century, and is now on the wane. As the epidemic developed, the risk of PU increased in successive generations throughout life. Then the epidemic diminished in successive generations. The risk of gastric ulcer (GU) was highest in people born around 1885, while the risk of duodenal ulcer (DU) was highest in those born about 10-30 years later. H. pylori infection offers an inadequate explanation of the PU epidemic. Although the epidemic coincided with a major rise in cigarette smoking, PU then declined in spite of an increased incidence of smoking. None of the other possible causes of ulcer (non-steroidal anti-inflammatory drugs, stress or diet) satisfactorily explains the epidemics of GU and DU and their asynchronicity. The best, but inadequate, explanation for the epidemic is the coincidence of the acquisition of a new potent strain of H. pylori in childhood and the uptake of smoking in adult life.
幽门螺杆菌已被确认为消化性溃疡（PU）的病因。人们对消化性溃疡的流行情况了解较少，这种流行始于19世纪中叶左右，在世纪之交达到顶峰，如今正在消退。随着这种流行的发展，消化性溃疡的风险在一生中逐代增加。然后这种流行在逐代中减弱。胃溃疡（GU）的风险在1885年左右出生的人群中最高，而十二指肠溃疡（DU）的风险在大约10至30年后出生的人群中最高。幽门螺杆菌感染不足以解释消化性溃疡的流行。尽管这种流行与吸烟的大幅增加同时发生，但消化性溃疡随后仍有所下降，尽管吸烟率有所上升。溃疡的其他可能病因（非甾体抗炎药、压力或饮食）均无法令人满意地解释胃溃疡和十二指肠溃疡的流行情况及其不同步性。对这种流行的最佳但并不充分的解释是儿童期感染一种新的强效幽门螺杆菌菌株与成年后吸烟行为的巧合。
