[Peptic ulcer, Helicobacter pylori]

The etiology of gastric or duodenal ulcer defines the choice of treatment. In patients with H. pylori infection but without NSAID treatment of the acute ulcer is achieved by a one week eradication therapy. Prolonged treatment with acid inhibitors is usually not necessary. Eradication should be done by a triple therapy consisting of one acid inhibitor and two antibiotics. Success of the eradication should be controlled 4 weeks after end of the treatment by a C13-urea breath test. Serology is not useful for this matter. NSAID induced ulcers without H. pylori infection should be treated for 4-6 weeks with a potent acid inhibitor, preferably a proton pump inhibitor. If NSAID is continued afterwards prophylaxis against ulcer relapse is necessary. Prostaglandin analog Misoprostol is the only well established drug for that. Proton pump inhibitors seemed also to prevent NSAID ulcer, but solid publications are lacking. H. pylori and NSAID are independent risk factors. Thus. H. pylori eradication does not necessarily prevent relapse of NSAID induced Ulcers. Relapse prophylaxis by Misoprostol or possibly by PPI seems advisable. Ulcer without H. pylori infection and without NSAID is seldom. Other reasons, such as carcinoma, Whipple's disease or Zollinger-Ellison syndrome has to be ruled out. False negative H. pylori tests should be excluded by searching for H. pylori with other methods.