[Gastric and duodenal ulcers--etiopathogenesis, diagnosis and therapy at the milestone of the 20th century]

Abstract

Peptic ulcer disease has been still very actual topic as 10% of western population would fell ill during its life. Substantial changes in understanding of etiopathogenesis were achieved within last hundred years. The first milestone means development of gastric physiology (gastric secretion, histamine, gastrin, cyclo-oxygenase, H2-receptors, proton pump). There is no doubt peptic ulcer is a typically human disease with involvement of the cortico-visceral axis and psychosomatic traits. Others factors play their role in the etiopathogenesis (like genetic, ethnic, environmental and socio-economic factors). However, main etiologic factors are Helicobacter pylori (approximately 90% duodenal and 50% gastric ulcers) and non-steroidal anti-inflammatory drugs (approximately 30% gastric and 10% duodenal ulcers). Diagnostics were determined by technical progress most of all by the construction of flexible digestive endoscopes into clinical practice. Surgery has been step by step replaced by pharmacotherapy (H2-receptor antagonists, proton pump inhibitors, Helicobacter pylori eradication). In near future we can expect further decrease in prevalence of peptic ulcer disease and gastric cancer in developed countries and increase in gastro-oesophageal reflux disease. Let us hope that current controversies in indication of eradication therapy will be overcome by vaccination against Helicobacter pylori.