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Abstract
Peptic ulcer disease had a tremendous effect on morbidity and mortality until the
last decades of the 20th century, when epidemiological trends started to point to
an impressive fall in its incidence. Two important developments are associated with
the decrease in rates of peptic ulcer disease: the discovery of effective and potent
acid suppressants, and of Helicobacter pylori. With the discovery of H pylori infection,
the causes, pathogenesis, and treatment of peptic ulcer disease have been rewritten.
We focus on this revolution of understanding and management of peptic ulcer disease
over the past 25 years. Despite substantial advances, this disease remains an important
clinical problem, largely because of the increasingly widespread use of non-steroidal
anti-inflammatory drugs (NSAIDs) and low-dose aspirin. We discuss the role of these
agents in the causes of ulcer disease and therapeutic and preventive strategies for
drug-induced ulcers. The rare but increasingly problematic H pylori-negative NSAID-negative
ulcer is also examined.