Lancet Seminar: Peptic Ulcer Disease in the Era of Declining H. pylori and Rising Drug Complexity
This Lancet seminar reviews the evolving landscape of peptic ulcer disease, where declining Helicobacter pylori prevalence and widespread proton pump inhibitor use have reduced overall incidence, but rising antimicrobial resistance and complex antithrombotic regimens create new diagnostic and therapeutic challenges. For laboratory medicine, the review highlights the increasing importance of H. pylori susceptibility testing to guide eradication therapy in the face of growing clarithromycin and metronidazole resistance.
The original study
Peptic ulcer disease.
- Authors
- Lanas A, Chan FKL
- Journal
- Lancet (London, England)
- Type
- Journal Article, Research Support, Non-U.S. Gov't, Review
- PMID
- 28242110
Original abstract
The rapidly declining prevalence of Helicobacter pylori infection and widespread use of potent anti-secretory drugs means peptic ulcer disease has become substantially less prevalent than it was two decades ago. Management has, however, become more challenging than ever because of the threat of increasing antimicrobial resistance worldwide and widespread use of complex anti-thrombotic therapy in the ageing population. Peptic ulcers not associated with H pylori infection or the use of non-steroidal anti-inflammatory drugs are now also imposing substantial diagnostic and therapeutic challenges. This Seminar aims to provide a balanced overview of the latest advances in the pathogenetic mechanisms of peptic ulcers, guidelines on therapies targeting H pylori infection, approaches to treatment of peptic ulcer complications associated with anti-inflammatory analgesics and anti-thrombotic agents, and the unmet needs in terms of our knowledge and management of this increasingly challenging condition.