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Endoscopy 2004; 36(1): 42-47
DOI: 10.1055/s-2004-814115
State of the Art Review
© Georg Thieme Verlag Stuttgart · New York

Ulcers and Gastritis

M.  P.  Dore1 , D.  Y.  Graham2
  • 1Institute of Clinical Medicine, University of Sassari, Sassari, Italy
  • 2Veterans' Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
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Publication History

Publication Date:
14 January 2004 (online)

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Significant advances continue to be made in the area of gastritis and ulcer disease. Studies to identify the most appropriate use of capsule endoscopy have now confirmed that it is superior to other methods for identifying small-bowel mucosal pathology and sites of obscure gastrointestinal bleeding. It has increasingly been recognized that the complications of ulcer disease are secondary to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and to interactions between NSAIDs and Helicobacter pylori. Effective prophylaxis for NSAID ulcers in H. pylori-negative individuals continues to be a challenge, as it has become clear that conclusions from studies focusing on ”endoscopic ulcers” in patients whose H. pylori status was unknown provided a false sense of security. The concept of multifocal atrophic gastritis has been challenged. The precursor lesion to gastric cancer now appears to be a sheet of pseudopyloric metaplasia advancing into the gastric body with islands of intestinal metaplasia embedded within it. Multifactorial models such as those proposed for understanding periodontal disease, including the organism, environmental factors, and host factors, appear particularly applicable to understanding the pathogenesis of H. pylori-associated gastric cancer.

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D. Y. Graham, M. D.

Veterans’ Affairs Medical Center

Room 3A-320 (111D) · 2002 Holcombe Boulevard · Houston, TX 77030 · USA

Fax: + 1-713-790-1040

Email: dgraham@bcm.tmc.edu