My name is Sheila Crowe.
I'm a professor of
medicine at the University
of California in San Diego.
I'm going to be discussing acid
peptic diseases of the stomach
and duodenum, including H. pylori
infection and NSAIDs.
To start, I would like to talk
about the clinical presentations
of H. pylori infection.
The most common presentation is
an asymptomatic infection in which
the patient has no
idea they're infected.
Another presentation is indigestion,
or what we call this dyspepsia.
Additionally, H. pylori can
lead to gastric ulcer and also
Perhaps one of the more serious
long term presentations of H. pylori
infection is the development
of gastric adenocarcinoma,
and a relatively rare presentation
is a special kind of lymphoma known
as the MALT lymphoma,
because it involves
the Mucosal Associated
In modern times, we've recognized
that this infection, which we think
dates back many years, has
actually changed in its incidence
in association with different
upper gastrointestinal diseases.
If you look at the graph, you
will see the relative incidence
of the event, the different types of
presentations of upper GI problems,
and you'll see over the
decades going from 1900
to more modern times that there
has been a decline in the H. pylori
infection, and with that you see
a decrease in duodenal ulcer,
gastric ulcer, and in Western
countries, gastric cancer.
At the same time, there have been
some other changes, which we won't
get into much detail here, is
the rise of reflux esophagitis,
Barrett's esophagus, and
adenocarcinoma of the esophagus.
Now this diagram does not apply
to Eastern countries and some more
of the developing countries
in the world where
H. pylori remains quite prevalent.