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Article
July 14, 1993

Gastroenterology

JAMA. 1993;270(2):206-209. doi:10.1001/jama.1993.03510020074022
Abstract

One of the strongly held notions of medical pathophysiology is that acid is the primary cause of duodenal ulcers. Indeed, the term acid-peptic disease reflects the prevailing concept of cause, and so therapy is aimed primarily at acid. "Antacids," such as acid-neutralizing compounds, histamine2 blockers, or proton pump inhibitors, are indisputably effective in healing ulcer disease and, if taken chronically, in preventing recurrence. It now appears, however, that an even more important factor may be responsible for ulcers (at least duodenal ulcers): infestation with Helicobacter pylori. Two important lines of evidence now support a possible causal role. First, H pylori is present in the antrums of virtually all persons with a duodenal ulcer who do not use nonsteroidal anti-inflammatory drugs or do not have Zollinger-Ellison syndrome as a possible cause of ulcer. Second, treatment and eradication of H pylori dramatically reduces the frequency of ulcer recurrence compared with treatment of

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