Peptic ulcer disease etiology

There are certain histologic subtypes of diffuse, aggressive NHL that respond less well to treatment with conventional regimens such as CHOP. Burkitt s lymphoma, lymphoblastic lymphoma, mantel cell lymphoma, and primary CNS lymphoma are examples of disease that benefit from more intensive therapy. Regimens such as hyper-CVAD, which alternate cycles of hyperfractionated cyclophosphamide, doxorubicin, vincristine, and dexamethasone with high-dose cytarabine and methotrexate, often are substituted for CHOP. Intrathecal therapy with methotrexate is indicated with documented CNS infiltration of tumor or involvement of the sinuses. The recent appreciation of the etiology of Helicobacter pylori in the etiology of peptic ulcer disease and the association between colonization and mucosal-associated lymphoma (MALT) has spurred... 

The answer is d. (Hardman, pp 909-910.) It is now recognized that infection with fi pylon is a major etiologic factor in peptic ulcer disease. Bismuth salts are bactericidal for many organisms but especially for spirochetes. Colloidal bismuth salts such as bismuth subsalicylate also have a coating or cytoprotective action. Antimicrobials and GI antisecretory drugs are also used in combination with bismuth compounds. 

Other etiologies Congenital, idiopathic, hereditary (trypsinogen gene mutations), cystic fibrosis, inflammatory bowel disease, peptic ulcer disease, solid organ transplantation (liver, kidney, heart), refeeding... 

Peptic ulcer disease is much less common in the pediatric population than in adulthood. The classification of peptic ulcers is based on the region of involvement (gastric versus duodenal ulcers) and on the presence or absence of a known etiology (primary or secondary due to an underlying disease). Primary peptic ulcers are associated with H. pylori infection. Gastric ulcers are mostly seen in neonates (with or without the development of gastric perforation) while duodenal ulcers are much more common after the neonatal period. 

Nevertheless, despite the identification of a number of such associations with gastroduodenal ulceration, the etiology of the disease process was for the most part unrecognized until the identification of H. pylori and the elucidation of its relationship to peptic ulcer disease. 

H. pylori is a major etiological factor in gastroduodenal disorders such as chronic gastritis, peptic ulcer, and gastric cancer. Therefore, the treatment and prevention of these diseases would be facilitated by its eradication. At present, triple therapies that comprise two antibiotics (clarithromycin and amphotericin B) and a proton pump inhibitor are used to eradicate H. pylori. However, strains that are resistant to antibiotics have appeared. In addition, antibiotic treatment is associated with serious side effects such as nausea, vomiting, and diarrhea. Therefore, the discovery of novel antibacterial agents that are highly effective and safe is badly needed for the treatment of H. pylori infection. 

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