title: Possible absence of Helicobacter pylori in the early stages of duodenal ulceration.
abstract: BACKGROUND
  Helicobacter pylori is thought to be a cause of duodenal ulceration, but there is some evidence that it is found less often in early than in later disease.
  
  
  OBJECTIVE
  To assess the presence of H. pylori in patients undergoing endoscopy for dyspepsia, with respect to their duration of symptoms.
  
  
  METHODS
  Retrospective case note review.
  
  
  METHODS
  Patients were categorized as having a history greater or less than 6 months, and as H. pylori-positive or -negative, using biopsy rapid urease, culture and PCR tests.
  
  
  RESULTS
  Thirty-two duodenal ulcer patients with a history >6 months were all H. pylori-positive according to the PCR test; the five with a shorter history were H. pylori-negative. No patient H. pylori-negative by PCR was positive by the other tests.
  
  
  CONCLUSIONS
  H. pylori was (at least) less commonly present before 6 months. It is possible that H. pylori, although nearly always present after 6 months, is not present at the onset of the disease. Confirmation of this finding would imply that infection with the organism is not the cause of duodenal ulceration, but a factor producing recurrence and chronicity.
authors.affiliation: Department of Surgery, Royal Free and University College Medical School, London, UK.
authors.forename: P B
authors.initials: PB
authors.lastname: Boulos
authors.forename: A
authors.initials: A
authors.lastname: Botha
authors.forename: M
authors.initials: M
authors.lastname: Hobsley
authors.forename: J
authors.initials: J
authors.lastname: Holton
authors.forename: A O
authors.initials: AO
authors.lastname: Oshowo
authors.forename: F I
authors.initials: FI
authors.lastname: Tovey
mesh_terms: D004381:Duodenal Ulcer / Q000382:microbiology*; D005260:Female; D016481:Helicobacter Infections / Q000382:microbiology*; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors