<i>Helicobacter pylori</i>-Negative Duodenal and Pyloric Ulcer: Role of NSAIDs

Abstract

To investigate the frequency of use of nonsteroidal anti-inflammatory drugs (NSAID) in duodenal or pyloric ulcer patients who do not have Helicobacter pylori gastritis, we retrospectively analyzed the use of these drugs among 16 patients who had an endoscopically diagnosed duodenal or pyloric ulcer but had a histologically normal and noninfected stomach, and compared this frequency of use of NSAIDs with that in three control groups. The 16 patients are a consecutive subgroup (2.3%) from 707 patients who were endoscopically diagnosed as having duodenal or pyloric ulcer in Jorvi Hospital during 1985-1994. In all 16 patients, endoscopical and clinical appearances of the ulcers were seen by the clinician similar to those in ordinary peptic ulcer disease. The ulcers occurred at the same site in the duodenal bulb and pylorus as the ordinary peptic ulcers but tended to bleed more often: endoscopy was done more frequently among the 16 gastritis-negative patients because of ulcer bleeding than among the controls. Thirteen of the 16 patients (81%; CI95: 62-100%) did use NSAIDs. This frequency was higher (p < 0.05) than the corresponding frequency of the use of NSAIDs in any of the three control groups, i.e. (a) H. pylori-positive duodenal or pyloric ulcer patients [16 of 39 (41%)], (b) H. pylori-negative nonulcer patients [11 of 64 (17%)] or (c) H. pylori-positive nonulcer patients [14 of 42 (33%)]. We conclude that the history of use of NSAIDs is more common in duodenal and pyloric ulcer patients who have a normal, noninfected stomach than the history of use of NSAIDs in those in whom the ulcer is associated with H. pylori gastritis.

Helicobacter pylori -negative gastric and duodenal ulcers

“…Although the urea breath test, one of the most sensitive tests for diagnosing H. pylori infection, was not performed in our study, we consider that our data are reliable because we visualized H. pylori distribution by phenol red dye endoscopy to avoid false-negative results with biopsies, and we diagnosed H. pylori infection both with biopsy materials and with serum anti-H. pylori IgG antibody. The H. pylorinegative rate in the report of McColl et al 9 was also reliable, since a 14 C-urea breath test was performed and the presence of serum anti-H. pylori IgG antibody was 7 In the report of Hyvarinen et al, 10 there were no precise descriptions of histological diagnosis, but patients in whom H. pylori bacilli were not detected but in whom gastritis was present may have been diagnosed as H. pylori-positive. None of the previous five reports compared the H. pylori-negative rate in patients with GUs with that in DU patients.…”

“…Borody et al 6 reported that 38% of GU patients were H. pylori-negative. The incidence of H. pylorinegative DU patients was 23% according to Nessay et al, 7 6% according to Borody et al, 8 and 2.8% in the report of McColl et al 9 Hyvarinen et al 10 showed that 2.3% of duodenal or pyloric ulcer patients were H. pylori-negative. Except for the reports of McColl et al and Hyvarinen et al, the incidence of H. pylori-negative patients was much higher than our data showed.…”

Changing prevalence of upper gastrointestinal disease in 28 893 Koreans from 1995 to 2005

“…That is, the prevalence of H. pylori-negative peptic ulcers in the USA and Australia is relatively high, at 27-43%, and relatively low in Europe and Japan, at 2.7-8.0% [31][32][33][34][35][36]. This could be explained from the fact that the infection rate of H. pylori fell more rapidly in the USA and Australia.…”

Current indications for acid suppressants in Helicobacter pylori -negative ulcer disease

“…21 The sensitivity of the 13 C-UBT increased to 91, 97 and 100% after, respectively, 3, 7 and 14 days o lansoprazole. Bravo et al found that lansoprazole produced false-negative rates of 30±40% for the 13 C-UBT and 15±25% for the HpSA stool antigen test. 22 Bismuth subsalicylate treatment was associated with a false-negative rate of 45±55% for the 13 C-UBT and 10±15% for the HpSA stool antigen test.…”

“…Bravo et al found that lansoprazole produced false-negative rates of 30±40% for the 13 C-UBT and 15±25% for the HpSA stool antigen test. 22 Bismuth subsalicylate treatment was associated with a false-negative rate of 45±55% for the 13 C-UBT and 10±15% for the HpSA stool antigen test. 22 Ranitidine had no signi®cant e ect on the sensitivity of either test.…”