Prevalence and risk factors of Helicobacter pylori-negative peptic ulcer -A multicenter study

Peptic ulcer disease (PUD) has been described in the absence of Helicobacte r pylori (Hp) infection. suggesting that different factors are involved in its etiopathogenesis. We investigated prevalence and characteristics of Hp- negative (Hp-) PUD in an tea of Northern Italy and calculated the rate of H p-positive (Hp+) patients with PUD in whom Hp might be coincidental and not causal. Four hundred nine consecutive patients with endoscopically diagnos ed PUD were enrolled in seven hospitals. Hp infection was assessed by rapid urease test and histologic examination. The attributable risk percentages in different age groups were calculated by appropriate formulas. Of 409 pat ients. 31 (7.6%) were Hp- (gastric, 8.3%; duodenal, 7.6%). Age, nonsterioda l antiinflammatory drug (NSAID) consumption. and complication rates were si gnificantly higher in Hp- than Hp+ patients with duodenal ulcers (DUs). Of the Hp-patients with DU, 58% did not use NSAIDs. In patients with Hp+ DU, t he attributable risk percentage for Hp infection in patients aged <40 years , 40-60 years, or >60 years was 98%, 88%, and 66%, respectively. The preval ence of Hp- PUD was about 8%, mainly unrelated to any known etiologic facto r, in about one-third of Hp+ patients with PUD aged over 60 years, Hp infec tion might be coincidental and nor causal.