# Video research-update insert: H. pylori as a primary cause of peptic ulcer disease

Editorial script and storyboard insert, 5 October 2026. No rendered video. Read alongside the original review; no new grade is announced.

## Narration

Eradication trials strongly support a causal contribution to infected peptic-ulcer disease. NSAID-associated, idiopathic and time-dependent bleeding outcomes define remaining questions rather than overturning the established infected-disease result.

In the 1985 study, bacterial ingestion produced histologically documented gastritis. Gastritis in one volunteer is not a controlled demonstration of chronic ulcer sufficiency. [P3982345]

In the 1997 study, eradication reduced ulcer occurrence during subsequent naproxen use. Prevention at NSAID initiation differs from established chronic NSAID use. [P9329511]

In the 2022 study, early bleeding prevention benefit was not sustained with longer follow-up. Time-varying effects and low event incidence matter; later HTA reporting is the same trial. [P36335970]

The next discriminating question is: Why does bleeding-prevention benefit vary with time? Reinfection, competing disease, medication changes or time-dependent susceptibility may contribute. Extended randomized-trial follow-up with repeat infection testing, medication ascertainment and prespecified time-varying/competing-risk analyses.

The timeline shows selected changes in evidence, not inevitable progress or proof of a single cause. The review’s archived grade remains unchanged; the depth of source reading is documented in the update.

## Storyboard and source locks

| Insert | Visual | Narration anchor | Sources |
|---|---|---|---|
| Opening | Claim and bounded update statement | First paragraph | Review claim and source ledger |
| Timeline 1985 | Dated study card with design, result and limit | Bacterial ingestion produced histologically documented gastritis. | [P3982345](https://pubmed.ncbi.nlm.nih.gov/3982345/) |
| Timeline 1997 | Dated study card with design, result and limit | Eradication reduced ulcer occurrence during subsequent naproxen use. | [P9329511](https://pubmed.ncbi.nlm.nih.gov/9329511/) |
| Timeline 2022 | Dated study card with design, result and limit | Early bleeding prevention benefit was not sustained with longer follow-up. | [P36335970](https://pubmed.ncbi.nlm.nih.gov/36335970/) |
| G1 | Question → competing explanation → discriminating test | Why does bleeding-prevention benefit vary with time? | [P36335970](https://pubmed.ncbi.nlm.nih.gov/36335970/), [P8419816](https://pubmed.ncbi.nlm.nih.gov/8419816/), [P1558340](https://pubmed.ncbi.nlm.nih.gov/1558340/) |
| G2 | Question → competing explanation → discriminating test | Which patients need both eradication and protection against another cause? | [P9329511](https://pubmed.ncbi.nlm.nih.gov/9329511/), [P11274623](https://pubmed.ncbi.nlm.nih.gov/11274623/), [P36335970](https://pubmed.ncbi.nlm.nih.gov/36335970/) |
| G3 | Question → competing explanation → discriminating test | What explains verified infection-negative ulcers? | [P19445937](https://pubmed.ncbi.nlm.nih.gov/19445937/), [P11274623](https://pubmed.ncbi.nlm.nih.gov/11274623/) |
| G4 | Question → competing explanation → discriminating test | How much benefit is mediated by altered acid physiology? | [P8174954](https://pubmed.ncbi.nlm.nih.gov/8174954/), [P8419816](https://pubmed.ncbi.nlm.nih.gov/8419816/) |

## Editorial constraints

- Use the primary-source links shown above and keep the inference limit on screen with each milestone.
- Do not narrate an abstract check as complete-paper examination, a model result as human proof, or an unresolved inference as absence of all research.
- Preserve trial endpoint hierarchy, cohort reuse, correction notices and online/issue dates.
- Use original graphics made from this ledger. Publisher figure imagery has not been cleared or supplied for video reuse.
- Confirm any change in verdict through a separate documented HSEF review; this insert makes none.