Helicobacter pylori, Causation, Change in Natural History, and whyHelicobacter-Positive Duodenal Ulcers Should Not Be Routinely Treated

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Abstract
The relationship between Helicobacter pylori and duodenal ulcer is reviewed with regard to the following epidemiologic issues: causation, change in natural history, and whether there is sufficient evidence to treat H. pylori-positive peptic ulcers routinely. There is mounting evidence for a pivotal role of H. pylori as a precipitating cause of duodenal ulcers. There is insufficient data to conclude that eradication of H. pylori alone will cure peptic ulcer disease--that is, preventing instead of controlling relapse. H. pylori-positive duodenal ulcers should not be routinely treated because eradication rates need to be improved, metronidazole resistance is an increasing problem, and side-effects of currently used triple combination treatments are substantial.