Against reductionism

摘要

Both positions in the head to head debate "Does Helicobacterpylori really cause duodenal ulcers?" reflect a pathophysiological reductionism that should have long since become obsolete.12 Just as high cholesterol is not "the cause" of myocardial infarction but one of many risk factors, H pylori is best seen as one among several risk factors for ulcer.The evidence: most people living with Helicobacter never develop ulcers, some 30% of patients with ulcer do not harbour H pylori infection (with a substantial proportion also lacking exposure to non-steroidal anti-inflammatory drugs), and some patients whose Helicobacter colonisation has been eliminated by antibiotics subsequently develop new ulcers.34 These facts make it clear that other risk factors, including gastric acid hypersecretion, smoking, , psychological stress, and genetic predisposition, play a part in ulcer formation even in the many cases where Hpylori is probably directly implicated.