Risk factors for ulcer development in patients with non-ulcer dyspepsia: a prospective two year follow up study of 209 patients

Abstract

Background and aims: A subset of non-ulcer dyspepsia (NUD) disorders can evolve into peptic ulcer disease. This prospective study attempted to determine the independent risk factors for ulcer formation in NUD patients, and compared the natural history of Helicobacter pylori positive and negative NUD subjects. Methods: From May 1997 to April 1999, consecutive NUD patients were enrolled into the study. Endoscopy was performed routinely on enrolment, at the end of the second and 12th months, and whenever there was a dyspepsia attack. Patients were prospectively followed up for two years. Results: Peptic ulcers occurred in 16 of 209 NUD patients during the two year follow up period. Multivariate analysis of 13 host and bacterial factors demonstrated that advanced age (odds ratio 2.90), H pylori infection (odds ratio 3.59), and use of non-steroidal anti-inflammatory drugs (NSAID; odds ratio 4.46) were independently significant in predicting subsequent peptic ulcer development. NUD patients with all three risk factors had a 75% (3/4) risk of developing peptic ulcer but the ulcer incidence in patients without any of the risk parameters was only 1.2% (1/84). The resolution rate of symptoms in the H pylori positive NUD patients was similar to the H pylori negative patients (57.9% v 49.1%; 95% confidence interval (CI) −5 to 22). However, rates for subsequent peptic ulcer and erosion development were significantly higher in H pylori positive patients than in H pylori negative patients (ulcer 12.6% v 3.5%, 95% CI 1-16; erosion 23.2% v 12.3%, 95% CI 1-21). Conclusion: A small but significant proportion of NUD patients develop peptic ulcer after long term follow up. H pylori infection, NSAID use, and advanced age are independent risk factors for subsequent ulcer formation. Follow up endoscopy is strongly indicated for an NUD patient with multiple risk factors for ulcer formation when symptoms recur.

α1-Antitrypsin Precursor in Gastric Juice Is a Novel Biomarker for Gastric Cancer and Ulcer

“…The healthy subjects that were recruited from our health examination clinics had no clinical history of gastrointestinal diseases, and their endoscopic findings were normal or showed only mild gastritis. The diagnosis of gastric ulcer and duodenal ulcer was confirmed by endoscopic examination (15). The patient exclusion criteria included (a) the use of proton pump inhibitors, H2-receptor antagonists, or nonsteroidal anti-inflammatory drugs within 4 weeks before the study; (b ) coexistence of two kinds of gastroduodenal lesions; (c) presence of upper gastroduodenal bleeding; and (d) coexistence of severe systemic diseases.…”

Risks of interleukin‐1 genetic polymorphisms and Helicobacter pylori infection in the development of gastric cancer

“…However, only approximately 20% of infected individuals develop clinically significant diseases, such as peptic ulcer, gastric adenocarcinoma or mucosa-associated lymphoid tissue lymphoma. [1][2][3][4] It remains unclear which host, bacterial and environmental factors are the critical determinants that affect the outcomes of infected individuals. It has been suggested that phenotypic or genotypic differences amongst bacterial strains may account for the development of severe diseases.…”

Infección por Helicobacter pylori en pacientes sintomáticos con patología gastroduodenal benigna: Análisis de 5.664 pacientes

“…En nuestro entorno de infección casi universal la indicación de erradicación de H. pylori a todos los pacientes dispépticos tiene múltiples implicancias potenciales, que demandan estudios de costo-efectividad aún no disponibles. En el intertanto, erradicar al menos a aquellos con gastropatía erosiva parece una conducta razonable, sobre todo considerando la reconocida asociación entre erosiones antrales y úlcera péptica 21 y el hecho de que hasta 8% de los pacientes dispépticos con endoscopia normal desarrollan una úlcera durante el seguimiento 22 . Es plausible suponer que el grupo con erosiones antrales concentre especialmente a los ulcerosos no reconocidos, que son precisamente los que más se benefician de la erradicación de H. pylori.…”