The diagnosis of peptic ulcer must be precise and based on both endoscopic examination (in the case of gastric
ulcer to differentiate between benign or malign ulcers), and on bioptic examination. Peptic ulcer is pathogenetically
associated with H. pylori. A small group of patients with duodenal ulcers and without H. pylori or without an other
known cause (NSAID, etc.) is a poorly defined sub-group of patients. H. pylori has an important role in the
pathogenesis of gastritis and bulbitis. Both states are involved in the pathogenesis of peptic ulcer. If H. pylori is
eradicated, inflammatory changes of the gastric and duodenal mucosa recede and the recurrence of peptic ulcer
decreases to a minimal size. For estimation of H. pylori, several invasive and non-invasive techniques are used.
Among invasive methods most used in peptic ulcers, a combination of the rapid urease test and histology seems to
be the most important. Among non-invasive methods, the breath tests are the most reliable. The treatment is focused
on the eradication of H. pylori (no H. pylori is found one month or more after completed therapy). Of the eradication
regimens, the triple therapy with proton pump inhibitors, claritromycin and metronidazole or amoxicilin are most
effective. If this therapy fails, quadrutherapy (triple therapy combined with colloid bismuth subcitrate) may be
successful. The precise diagnosis of peptic ulcer and H. pylori infection is a basic prerequisite for rational therapy
of peptic ulcer disease and its relapses.
peptic ulcer, Helicobacter pylori, diagnosis, therapy.