The treatment of peptic ulcer disease

The literature published in the period under review identified some areas of key clinical and scientific importance in the treatment of peptic ulcer disease. Attention was drawn to the possibility that Helicobacter pylori may be less important as an etiologic factor in ulcer disease in the United States than in the rest of the world. The usual large number of papers addressed various treatment regimens, and the issue of H. pylori resistance to antibiotics was prominent. The introduction of the cyclooxygenase enzyme 2 (COX-2)-specific inhibitors promises to significantly affect nonsteroidal anti-inflammatory drug (NSAID) gastropathy. The review period produced some excellent papers (mainly review papers) on this topic, but there is a paucity of peer-reviewed data on the clinical application of COX-2 NSAIDs. Perhaps more important is that some authors, using a variety of animal models, protested the blithe acceptance of the COX-2 concept, questioning the idea of "specificity" and identifying possible problems with respect to ulcer healing. Observations of potential clinical importance with regard to the phenomenon of acid rebound after proton-pump inhibitor therapy were presented, and the role of H. pylori in the management of nonulcer dyspepsia remains controversial, despite the publication of three of the best-designed studies to date on this important topic.