Non-Helicobacter pylori and non-NSAID peptic ulcer disease in the Japanesepopulation

Background Helicobacter pylori and non-steroidal antiinflammatory drugs (NS AIDs) are recognized as the major causes of peptic ulcer disease. The statu s of H. pylori infection in the background population may influence the inc idence of H. pylori-negative peptic ulcer disease. Objective To examine the incidence of H. pylori-negative peptic ulcer disea se without intake of NSAIDs in Japan. Patients A total of 398 patients who had no eradication therapy for H. pylo ri prior to this study, including 246 patients with gastric ulcer (GU) and 152 patients with duodenal ulcer (DU), were enrolled. Methods H. pylori status was assessed by rapid urease tests, histological e xaminations (haematoxylin & eosin stain, Giemsa stain and/or immunostaining ) and serum IgG antibody. Two biopsy specimens were taken from the antrum w ithin 3 cm of the pyloric and two from the middle corpus of the stomach, al ong the greater curvature. Patients were asked a series of questions regard ing risk factors, including the use of NSAIDs. The presence of gastritis, g astric atrophy and intestinal metaplasia was examined according to the upda ted Sydney system. Results Of the 246 patients with GU, 12 patients (4.9%) were considered to be H. pylori-negative. Of the 152 patients with DU, two patients (1.3%) wer e considered to be H. pylori-negative. Hence, a total of 14 patients were f ound to be H. pylori-negative, Nine of them were taking NSAIDs, Consequentl y, the frequency of H. pylori-negative ulcer without intake of NSAIDs was 1 .3%. There was no significant difference in the frequencies of H. pylori-ne gative patients between the GU and DU groups. Conclusion The incidence of H. pylori-negative peptic ulcer disease without intake of NSAIDs was very low in the Japanese population, (C) 2000 Lippinc ott Williams & Wilkins.