NONULCER DYSPEPSIA IN A DUTCH WORKING POPULATION AND HELICOBACTER-PYLORI - ULCER HISTORY AS AN EXPLANATION OF AN APPARENT ASSOCIATION

Background: There is considerable debate about whether Helicobacter-py lori infection is important in causing nonulcer dyspepsia. Many studie s assessing this relationship have been performed in selected patient populations and included patients with a history of peptic ulcer. Gene ral population-based data with attention to ulcer history are needed t o clarify this relationship. Methods: A questionnaire on ulcer history and dyspeptic symptoms during the preceding 3-month period was obtain ed from apparently healthy employees who underwent a periodic medical examination in the Netherlands. In addition, serum samples were analyz ed for anti-H pylori IgG antibodies. Results: A total of 427 men and 7 3 women, aged 22 to 69 years, participated in the study. None of the w omen but 27 men (6%) had a previous diagnosis of peptic ulcer. Among 1 9 unoperated-on men with verified duodenal (17 subjects) and gastric ( two subjects) ulcer, 89% were H pylori positive, while 74% had frequen t dyspeptic symptoms in the 3 months before the study. Among the 400 m en and 73 women without an ulcer history, the 3-month period prevalenc e of frequent dyspepsia was 13% and 21%, respectively. The rate of H p ylori positivity was 25% in subjects with nonulcer dyspepsia and 29% i n all others. The H pylori infection rate increased with age and with a lower occupational level but was independent of gender. In the male population, various differences in symptoms between H pylori-positive and H pylori-negative subjects could be detected when the 27 subjects with a history of ulcer were included, whereas these differences disap peared when these subjects were excluded. Conclusions: In the Dutch wo rking population, nonulcer dyspepsia is not related to H pylori infect ion, whereas for duodenal ulcer the relationship is clear. The apparen t association between dyspeptic symptoms and H pylori infection is ent irely accounted for by subjects with an ulcer history.