Ulcerogenesis: integrating the roles of Helicobacter pylori and acid secretion in duodenal ulcer.

Abstract

The pathogenesis of duodenal ulcer appears to be multifactorial, involving an imbalance between "aggressive" (e.g., acid and pepsin) and "defensive" (e.g., prostaglandin production, mucus/mucosal barrier, bicarbonate production, blood flow, cell regeneration) factors. Historically, the management of peptic ulcer disease has focused on controlling gastric acid secretion. Recent evidence suggests that Helicobacter pylori infection underlies many of the acid and gastrin abnormalities observed in duodenal ulcer disease and that it plays a pivotal role in the development of gastritis and ulceration.