The role of Helicobacter pylori in acid-peptic disease.

Acid peptic disease is common, and its management is costly. Less than a decade ago, the traditional theories regarding the etiology and pathogenesis of acid peptic disease were upset by the discovery of Helicobacter pylori infection in association with chronic active gastritis. A substantial body of investigation after that discovery has established this infection as the major cause of human chronic active gastritis and has defined a critical role for H. pylori in the etiology, pathophysiology, and treatment of duodenal ulcer disease. Furthermore, evidence is accumulating to link H. pylori to gastric ulcers, non-ulcer dyspepsia, and even gastric carcinoma. Research has clarified some unique features of the organism that have been put to advantage in the development of diagnostic tests, and it has also clarified some features of the infection that make it difficult to treat. Although treatment is decidedly beneficial for certain patient subsets, simpler and more effective therapy is needed.