The therapy of peptic ulcer disease has progressively changed in the last two centuries. Major discoveries were achieved by the possibility to directly visualize the first part of the gastrointestinal tract with endoscopy and by the availability of potent antisecretory agents. Then, since Helicobacter pylori was discovered, the cause of this disease was understood and the optimal therapy was found. The cure of the infection was not only able to heal the ulcer but also to cure the disease, interrupting its relapsing behaviour. Initially, dual therapy, a combination of a proton pump inhibitor with an antibiotic, demonstrated an overall efficacy for the eradication of H. pylori better than monotherapy, but still not satisfactory. Finally, a triple therapy of proton pump inhibitor, clarithromycin, and either amoxicillin or metronidazole, has been the most widely recommended eradication treatment.

Key concepts

• Neutralization of gastric acidity heals peptic ulcer but does not prevent relapse of Helicobacter pylori-related ulcer.
  
• H. pylori has been clearly related to gastritis, peptic ulcer (gastric and duodenal ulcer), gastric lymphoma and cancer.
  
• Eradication of H. pylori infection heals and prevents the peptic ulcer relapse.
  
• The triple therapy of proton pump inhibitor and two antibiotics (clarithromycin and either amoxicillin or metronidazole) is the most widely recommended eradication treatment for H. pylori infection.