Helicobacter pylori -negative gastric and duodenal ulcers

Abstract

It is unclear whether Helicobacter pylori infection is essential to the development of peptic ulcers. In this study, we examined the rates of H. pylori-negativity among patients with peptic ulcers. We also attempted to clarify the characteristics of H. pylori-negative peptic ulcers to throw light on the pathogenesis of peptic ulcers. The study included 215 consecutive patients with gastric ulcers (GUs) and 120 consecutive patients with duodenal ulcers (DUs). After routine endoscopic examination and phenol red dye endoscopy, forceps biopsies were performed for culture, histology, and the rapid urease test. A patient was considered H. pylori-negative when the serum anti-H. pylori IgG and the three tests on biopsied specimens were all negative. H. pylori-negative rates were 3.2% in the patients with GUs and 1.7% in the patients with DUs. Lack of atrophy of the gastric mucosa was significantly more common in the H. pylori-negative patients with GUs. A history of ulcer disease was less common and antral ulcers were more common in H. pylori-negative GU patients, but not significantly so. As the urea breath test had not been performed, the possibility of a false-negative result cannot be completely ruled out, but we believe that the H. pylori-negative rate in our study is more reliable than these rates in previous reports, because we visualized H. pylori distribution by phenol red dye endoscopy to avoid false-negative results in biopsies, and we used both biopsy and serum anti-H. pylori IgG findings to establish an H. pylori-negative diagnosis. Since H. pylori-negative peptic ulcers certainly exist, H. pylori infection is thought not to be essential to the development of peptic ulcers. There were few differences between the characteristics of H. pylori-negative and H. pylori-positive peptic ulcers in our study. A large-scale study is required to clarify the characteristics of H. pylori-negative peptic ulcers.

Canonical Correlation Analysis of Factors Involved in the Occurrence of Peptic Ulcers

“…Peptic ulcer disease is still highly associated with H. pylori infection (95.7% DU, 87% benign GU); only 1.6% of DU and 4.1% of GU were not associated with either H. pylori infection or NSAID use, as reported in Spain [16]. Similar results have been reported earlier for the Japanese patients; the investigators, in an attempt to clarify the characteristics of H. pylori-negative peptic ulcers, found very few differences between H. pylori-negative and H. pylori-positive peptic ulcers [17]. Xia et al [18] reported that GU associated with H. pylori infection and/or NSAID use occurred mostly in older people, whereas non-H. pylori, non-NSAID GU were more common in younger patients.…”

Has Peptic Ulcer Disease Changed During the Past Ten Years in Korea? A Prospective Multi-center Study

“…Compared with our results ten years ago, there has been a significant change in the prevalence of H. The prevalence of H. pylori infection in GU and DU showed increasing and decreasing trends, respectively, compared with our results from ten years ago. It has been shown in several studies that DU is more commonly related to H. pylori infection than GU [4][5][6]. Widespread eradication of H. pylori might have a more profound effect on the prevalence of DU than GU.…”

“…H. pylori infection has been found in 73-100% of patients with duodenal ulcers (DU) and 65-100% of patients with gastric ulcers (GU) [2][3][4][5][6][7]. Because H. pylori infection is generally regarded as a causal factor in the pathogenesis of PUD, it has been widely eradicated in Korea, similar to other countries.…”

Helicobacter pylori-Negative Nonsteroidal Anti-Inflammatory Drug-Negative Ulcer

“…[1][2][3][4][5] However, some ulcers are apparently unrelated to those risk factors, and there is considerable variation in the reported proportion of such ulcers. Recent reports from North America suggest that up to 50% of ulcers are H pylori negative, [6][7][8] whereas in other parts of the world, a proportion of H pylori-negative ulcers remains much lower at less than 5%.…”