ETIOPATHOGENESIS OF PEPTIC ULCER: back to the past?

Abstract

-Objective -To review some aspects of the etiopathogenesis of peptic ulcerous disease especially on the basis of studies on its correlation with Helicobacter pylori (H. pylori). Methods -A search was made in the data bases MEDLINE, LILACS and PubMed, and in Brazilian and foreign books, referring to the incidence and prevalence of infection by H. pylori and of peptic ulcerous disease in various populations of different countries. Results -It was observed that the prevalence of H. pylori infection is similar in individuals with peptic ulcerous disease and the general population. There are differences between countries with respect to the prevalence of infection and of gastric or duodenal peptic ulcers. In many countries the prevalence of infection by H. pylori shows stability while the prevalence of peptic ulcerous disease is declining. The prevalence of peptic ulcerous disease without H. pylori infection varies between 20% and 56% in occidental countries. Discussion -The observations might be suggestive of H. pylori being only one more factor to be summed together with other aggressive components in the genesis of peptic ulcerous disease. We would therewith be returning to the classic concept that peptic gastric and duodenal ulcers have multifactorial etiology and would result from imbalance between aggressive and defensive factors. The focus of studies should be enriched with the identification of the defensive factors and of other aggressive factors besides the well known H. pylori and non-steroidal anti-inflammatory drugs, since these two aggressors do not exhaust the full causal spectrum. HEADINGS -Peptic ulcer. Stomach Ulcer. Duodenal ulcer. Helicobacter infections.

Gastroprotective activity of the hydroethanolic extract and ethyl acetate fraction from Kalanchoe pinnata (Lam.) Pers.

“…A peptic ulcer is a chronic lesion, usually single, that can be located in the gastric or duodenal mucosae (Kumar, Abbas, Fausto, 2005). In the UK, the incidence of this disease was 12% higher in men than in women (Araujo, Borini, Guimarães, 2014). A review article (January 1980 to February 2009 showed that the incidence rate of uncomplicated peptic ulcers was approximately one case per 1000 people per year in the general population; the incidence rate for complicated peptic ulcers that included bleeding and perforation was approximately 0.7 cases per 1000 people per year (Lin, Rodrígues, Hernándes-Diaz, 2011).…”

Helicobacter pylori Strains from Duodenal Ulcer Patients Exhibit Mixed babA/B Genotypes with Low Levels of BabA Adhesin and Lewis b Binding

“…Helicobacter pylori infection is the principal cause of duodenal ulcers, and its treatment is accomplished by eradication of infection using multiple antibiotic regimens [1,34]. Among H. pylori virulence factors, BabA adhesin is recognized for its distinctive variability at different levels of genetic structure, protein expression and binding strength [10,17].…”

“…Helicobacter pylori establishes its virulence through adherence to the gastric epithelium, which results in gastric inflammation and high risk of gastrointestinal diseases, including duodenal ulcers [1] and gastric adenocarcinoma Majran Mohammadi is the first corresponding author.…”

Helicobacter pylori and Nonmalignant Diseases

“…The percentage of idiopathic ulcers increased from 10 to 21%, but the overall number did not rise (39 vs 34). A second review article also from Brazil concluded that PU had not declined over the past decade, the percentage of patients with ulcers without H. pylori or NSAID intake, however, had increased in some centers to more than 50%, and H. pylori was only one factor in the genesis of PUD which now had a multifactorial etiology. Two articles, one from Canada and the other from Croatia , reviewed the incidence of PU hemorrhage.…”