H. pylori infection generally occurred less among patients with complicated ulcer disease than in those with uncomplicated ulcer disease. Many studies point to aspirin or NSAIDs as the other identifiable risk or cause of PUD. PPI has been shown to reduce dyspeptic symptoms, which develop from NSAID use. In the past, lansoprazole was the only FDA-approved PPI. Recently, however, professors at the University Hospital, Queen's Medical Centre of Nottingham in the United Kingdom presented their findings on a comparison among PPIs. Their study was internationally-based with more than 500 patients. It showed that esomeprazole was superior to other PPIs in managing upper gastrointestinal symptoms of arthritic patients. It also enhanced their quality of life (Howden). PUD is not only likely to remain a persistent condition (Howden, 2003). More cases of ulcers unconnected with H. pylori infection can be expected to increase in the U.S. They will be highly attributable to aspirin or NSAID use. Bleeding frequently occurs among H-pylori-negative ulcers. And endoscopy is likely to remain the most reliable approach to bleeding peptic ulcers. Intravenous PPI therapy has yet to prove its worth in the approach (Howden). #

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