Natural history of campylobacter pylori in duodenal ulceration treated with an H 2-antagonist

Abstract

Campylobacter pylori has been associated closely with active antral gastritis and duodenal ulcer but its pathogenetic role remains uncertain. The present longitudinal study examined, prospectively, the endoscopic antral biopsies of 45 patients with duodenal ulceration, taken before and after healing of the duodenal ulcer, during remission and at relapse. The biopsies were examined for the activity and degree of chronic inflammation of the gastritis and for the occurrence and density of C.pylori by Warthin-Starry stain. Before treatment the frequency of chronic active antral gastritis was 100% and the occurrence of C.pylori was 97%. Compared with the pre-treatment state, there was no significant change in either the frequency and severity of antral gastritis, or in the occurrence and density of the bacteria in the antral mucosa at the time the duodenal ulcer healed, during remission, or at relapse. The occurrence of the bacteria was significantly more frequent during remission, than at the time when the ulcer had healed initially (P < 0.05). These results suggest that the bacterium may not play an important pathogenetic role in ulcer healing and relapse, when patients are managed using an H 2-blocker.