Multivariate Analysis of Risk Factors for Development of Duodenal Ulcer in Helicobacter pylori-Infected Patients

Abstract

Background: Although Helicobacter pylori is a significant etiologic factor of peptic ulcer disease, it remains unknown why ulcers develop only in the minority of infected individuals. Aim: The aim of this cross-sectional study was to evaluate the association between the presence of duodenal ulcer in H. pylori-infected patients and different risk factors. Methods: A total of 122 H. pylori-infected patients were enrolled; 79 had duodenal ulcer and 43 gastritis. Univariate analysis was conducted using either Fisher’s exact test or exact Cochrane-Armitage trend test. In multivariate analysis the logistic model was used. Results: Univariate analysis indicated six factors (male sex, smoking, antral H. pylori density, cagA presence in antrum, and vacA s1a presence in antrum and corpus). Four factors (sex, smoking-alcohol index, H. pylori density index, and cagA index) were found to be significant in multivariate analysis. The best model predicting duodenal ulcer included male sex, smoking, presence of H. pylori on histopathology in antrum and cagA presence in corpus. Conclusion: Although several risk factors were significantly associated with duodenal ulcer, we failed in the identification of either a single risk factor or a set of factors that can unequivocally differentiate patients with ulcer from those with gastritis.

Correlates shift work with increased risk of gastrointestinal complaints or frequency of gastritis or peptic ulcer in H. pylori-infected shift workers?

“…Our results suggest a strong correlation between smoking status and peptic ulcer frequency as previously shown by other authors (Chen et al 1999;Konturek et al 2003;Moshkowitz et al 2000;Regula et al 2003).…”

“…Schilling et al (2000) concluded that Hp infection status does not allow distinguishing ulcer or nonulcer dyspepsia patients from asymptomatic seropositives. In fact, only 10-20% of Hp colonizations result in duodenal or gastric ulcer disease because increased acidity is not mandatory in Hp-induced gastritis (Fennerty 2005;Marshall 2003;Kist and Glockner 2003;Regula et al 2003). From the present results, it is more likely that a disruption of the circadian periodic as result of chronic shift work is not a risk factor for a duodenal or gastric ulcer disease such as stress or smoking (Johns et al 2005;Jones 2006;Levenstein 2002;Regula et al 2003).…”

“…Today, it is assumed that H. pylori infection can result in chronic gastritis as well as in peptic ulcer, which may enhance the risk of gastric carcinoma or MALT lymphoma (Bruce and Maaroos 2008;Fennerty 2005;Johns et al 2005;Kist et al 2005;Marshall 2003;Regula et al 2003;Rothenbacher et al 1998;Schwarz et al 2008;Webb et al 1984). Most common risk factors for ulcus diseases are male gender, smoking and stress, while the significance of antral H. pylori density is discussed controversially (Chen et al 1999;Jones 2006;Konturek et al 2003;Levenstein 2002;Moshkowitz et al 2000;Regula et al 2003).…”

Identificação do Helicobacter pylori pela citologia do escovado gástrico: comparação com o método histológico

“…No processo de ulcerogênese, as pesquisas apontam para as cepas ulcerogênicas 22 associadas a características próprias do hospedeiro, as quais não foram objetos deste estudo.…”

Helicobacter pylori infection: anything new should we know?

“…However, in this study, the combination of colonization by H. pylori and NSAID use appeared to prevent the appearance of duodenal ulcer. In another study of 122 infected patients, multivariate analysis of host, strain and environmental factors did not identify any single factor or combination of factors that could differentiate unequivocally patients with duodenal ulcer compared to gastritis 17 . In humans, a long‐term study of asymptomatic blood donors who were colonized by H. pylori confirms that with time, a proportion go on to develop ulcer disease 18 .…”