Gastroduodenal disease is a common and very costly disease process in industrialized nations. Although primarily an adult disease, the frequency of diagnosis in children is increasing. The pathogenesis of gastroduodenal disease has been the topic of numerous studies. It may be a continuum with gastritis or duodenitis leading to local ulcerations. Over the last few decades, the back diffusion of hydrogen ions has been thought to be the primary cause of gastric mucosal damage. Therapy directed at inhibiting gastric acid secretion allows for short term resolution of symptoms and healing of ulcers; however, the relapse rate remains extremely high. Recent reports of bacteria isolated from adult gastric biopsies suggest a role for bacteria in the pathogenesis of gastroduodenal disease. These bacteria subsequently have been named Campylobacter pylori. We have isolated this organism from a number of our pediatric as well as adult patients who had evidence of chronic gastritis, gastric or duodenal ulcers. Anecdotal reports suggest antibiotic therapy will eradicate this organism and heal the ulcers. However,very little is known about the natural history of Campylobacter pylori. The proposed work will perform a clinical study to determine whether factors previously associated with peptic ulcer disease correlate with the presence of Campylobacter pylori as well as to investigate the natural history of Campylobacter pylori associated gastroduodenal disease in children and adults. Rapid screens will be used to identify patients with Campylobacter pylori at the time of endoscopy. Patients with Campylobacter pylori associated gastritis will be followed on a long term basis employing accepted therapeutic management and their course will be compared to similar patients without Campylobacter pylori. An enzyme linked immunoabsorbant assay (ELISA) will be used to measure isotype specific anti Campylobacter pylori antibodies in serum and mucosal secretions (saliva, gastric juice). By correlating antibody levels to patient symptoms and clinical course, we hope to be able to follow our patients' progress without invasive endoscopic procedures. Overall, this project will determine the relationship of Campylobacter pylori to previously associated risk factors of peptic ulcer disease as well as to define the long term natural history of Campylobacter pylori associated gastroduodenal disease in children and adults.
