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Peptic ulcer: an infectious disease?
1Department of Clinical Microbiology, University of Copenhagen, Rigshospitalet, Denmark.
Abstract:
Since the ingestion studies by Marshall and Morris, Helicobacter pylori has been known to cause both acute and chronic infection in the human stomach activating both the cellular and the humoral immune system. It is of little or no value to evaluate the causative relationship of an infectious agent using Koch's criteria. The more recent criteria for causative relationships used in the science of epidemiology are more useful. These criteria include: (i) the characteristic of the association which is fulfilled for most cases of both duodenal and gastric ulcer; (ii) the temporal relationship which is fulfilled for duodenal ulcer and has not been investigated for gastric ulcer; (iii) the biological gradient which has been fulfilled for duodenal ulcer in a few studies but not investigated for gastric ulcer; (iv) the biological plausibility which is easily fulfilled for both duodenal and gastric ulcer; (v) the effect of an intervention which has been fulfilled for duodenal ulcer and in a few studies for gastric ulcer; and (vi) the coherence of these data with what is known about the disease which is fulfilled for both duodenal and gastric ulcer. Even though there is no need for all criteria to be fulfilled, further studies are necessary to confirm the temporal relationship between H. pylori and peptic ulcer, and the biological gradient of H. pylori in relation to the gastric ulcer. Even so, there is a strong indication that most of the peptic ulcers, apart from those caused by non-steroid anti-inflammatory drugs and Zollinger-Ellison-like syndromes, are caused by H. pylori infection.
Insights
Helicobacter pylori infection is strongly indicated as the cause of most peptic ulcers. Further research is needed to confirm the temporal relationship and biological gradient for gastric ulcers.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Epidemiology
Background:
- Helicobacter pylori (H. pylori) infection activates human immune responses.
- Traditional Koch's criteria are less valuable for assessing H. pylori's role in peptic ulcers.
Purpose of the Study:
- To evaluate the causative relationship between H. pylori and peptic ulcers using epidemiological criteria.
- To assess the strength of evidence for H. pylori causing duodenal and gastric ulcers.
Main Methods:
- Application of modern epidemiological criteria for infectious disease causation.
- Review of existing data on association, temporal relationship, biological gradient, plausibility, intervention effects, and coherence.
Main Results:
- H. pylori fulfills most epidemiological criteria for duodenal ulcers.
- Biological plausibility and coherence are met for both duodenal and gastric ulcers.
- Evidence suggests H. pylori causes most peptic ulcers, excluding NSAID-induced and Zollinger-Ellison syndromes.
Conclusions:
- H. pylori is a likely cause of most peptic ulcers.
- Further studies are required to confirm the temporal relationship and biological gradient for gastric ulcers.
- The findings support H. pylori's role in peptic ulcer disease.