Clinical characteristics of Helicobacter pylori-negative duodenal ulcer disease.

Background/aims: Previous data on H. pylori-negative duodenal ulcer (DU) are limited due to different exclusion criteria adopted. In this study we attempted to clarify the characteristics of H. pylori-negative DU disease from patients referred for endoscopy.

Methodology: We recruited patients with DU disease and without H. pylori infection as confirmed by biopsy urease and 13C-urea breath tests. With each patient we carried out a structured personal interview including basic demographic and clinical data, personal habits, use of NSAIDs/aspirin, antibiotics, proton pump inhibitors (PPI) and anti-Hp therapy. If patients used antibiotics or PPI, a urea breath test was performed four or two weeks after discontinuation, respectively.

Results: The mean age of patients with H. pylori-negative DU was 60.3 years (20-87). Among the 66 H. pylori-negative DU patients, 34 (51.5%) had reported use of NSAID/aspirin, 24 (36.4%) had a history of previous eradication therapy. Among the 32 non-H. pylori and non-NSAID DU cases, five (15.6%) had psychophysical stress, four (12.6%) had co-morbid illnesses, and two (6.3%) were alcoholics.

Conclusions: NSAID/aspirin use is the most common cause of H. pylori-negative DU disease. Psychophysical stress, co-morbid illnesses, and alcohol abuse appear to be associated with the development of non-H. pylori and non-NSAID DU disease.