The potential impact of Campylobacter pylori on the treatment of duodenal ulcer disease.

In most studies the association between Campylobacter pylori infection, Type B gastritis and duodenal and gastric ulceration is extremely strong. The best evidence for it having an aetiological role is at present in Type B gastritis. It should be remembered, however, that serological studies show carriage of the organism to be common also in the general population. An attempt is made here to gain some idea of the clinical impact of C. pylori infection in duodenal ulcer disease by analysing clinical trials, and in particular relapse data, in which an agent which suppresses C. pylori is used (colloidal bismuth subcitrate) and compared with one which does not (an H2-receptor antagonist). A mathematical model based on the data from these studies predicts that the prevalence of active duodenal ulceration will be twice as common in a group of subjects treated repeatedly upon relapse with an H2-receptor antagonist as in a group treated with colloidal bismuth. Other possible mechanisms are discussed but the ability of bismuth to suppress C. pylori infection is perhaps the best available explanation at present. Early data from several centres suggest that patients who can be rendered C. pylori negative over a prolonged period of time are relatively immune from relapse of their duodenal ulcers. If confirmed this observation may well transform the long-term management of duodenal ulcer disease.