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In adults, peptic disease (PD) is an important public health problem because of its clinical and economic implications. In children it is a well-known problem, but its prevalence and relative complications are less well defined.

PD includes some gastric and duodenal diseases characterized by the presence of the digestive symptoms of dyspepsia, the endoscopic appearance of mucosal lesions, and the histological features of chronic inflammation. However, these three characteristics might be expressed in different ways, producing a mix of clinical pictures, which range from the asymptomatic patient with normal endoscopic picture and mild gastritis, to the patient with a bleeding peptic ulcer.

Gastritis, duodenitis, gastric and duodenal ulcer are the definitive diagnoses of a patient who has gone through the appropriate endoscopic and histological investigation of the upper gastrointestinal tract. This means that most of the findings belonging to the pre-endoscopic era (in children, before 1980) are not reliable and not comparable with more recent data.

The strict link between the above-mentioned pictures is based on two major pieces of evidence. First, is the presence of mucosal inflammation and ulcer in the same patient. Even if gastroduodenitis and ulcer could be seen as a continuum in the natural history of PD, the evolution toward the crater (ulcer) is not mandatory, and the majority of patients with PD show only gastritis. Second, is the existence of a common etiological factor of both gastritis and ulcer in the majority of patients: the Helicobacter pylori (H. pylori) infection.

The history of the H. pylori infection begins in 1982, and it is one of the most exciting examples of how a fortuitous observation has produced one of the greatest impacts on our knowledge and treatment of an old disease. The oversight of cultures of antral biopsies taken from patients with PD during some days of vacation allowed two Australian investigators, Barry Marshall and Robert Warren, to observe and describe the growth of colonies of previously unknown bacteria.1 As these Gramnegative, spiral bacteria had been isolated on Campylobacter-specAfic media, they were initially identified as Campylobacter-like organisms, but it soon became clear that H. pylori belonged to a new genus, taxonomically identified as Helicobacter, which, to date, consists of 19 zoonotic species with another ten potentially novel species. The official species differ in site of infection, which is the stomach in eight and the gut in 11, and in the host, but they show great homology in the analysis of 165 rRNA sequences (Table 6.1).2

During the past two decades, an impressive number of papers, consensus conferences, position documents and statements of the Gastroenterological Associations and Public Health Organizations (NIH) confirmed the existence of a strong association between H. pylori and PD. In particular, in 1994 a Consensus Conference of the NIH established the role of H. pylori in the pathogenesis and recurrence of peptic ulcer, emphasizing that the treatment of this condition should be considered the eradication of the H. pylori infection and not only the healing of the ulcer.3 In the same year, the International Agency for Research on Cancer included H. pylori in the list of the carcinogenic factors of class I, as the main developing factor in gastric carcinoma.4

Table 6.1 Natural hosts and usual site of isolation of Helicobacter species

Helicobacter species

Main host

Origin

H. pylori

human

gastric

H. mustelae

ferret

gastric

H. nemestrinae

macaque monkey

gastric

H. felis

cat, dog

gastric

H. acinonychis

cheetah

gastric

H. bizzozeronii

dog

gastric

H. salomonis

dog

gastric

H. heilmannii

human, cat, dog, pig

gastric

H. cinaedi

human, hamster

intestinal

H. fennelliae

human, hamster

intestinal

H. muridarum

rat, mouse

intestinal

H. canis

dog

intestinal

H. pullorum

poultry

intestinal

H. pametensis

tern

intestinal

H. hepaticus

mouse

intestinal

H. bilis

mouse

intestinal

H. cholecystus

hamster

intestinal

H. trogontum

rat

intestinal

H. rodentium

mouse

intestinal

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