title: The prevalence of peptic ulcer not related to Helicobacter pylori or non-steroidal anti-inflammatory drug use is negligible in southern Europe.
abstract: OBJECTIVE
  Helicobacter pylori is the major cause of peptic ulcer disease, but the proportion of H. pylori-negative peptic ulcers seems to be increasing in developed countries. We investigated the frequency of H. pylori-negative peptic ulcer without intake of nonsteroidal anti-inflammatory drugs (NSAIDs) in a Mediterranean European country.
  
  
  METHODS
  We prospectively collected consecutive patients with an endoscopically verified active peptic ulcer over 6 months from different areas of Spain. Helicobacter pylori infection was assessed by rapid urease test and histologic examination (corpus and antral biopsies). A (13)C-urea breath test was performed if H. pylori was not detected with the invasive test. Patients were considered H. pylori-negative if all three tests were negative. NSAID use was determined by structured data collection.
  
  
  RESULTS
  Of 754 consecutive peptic ulcer patients, 16 (2.1%) were H. pylori-negative and had not used NSAIDs before the diagnosis. Of the 472 patients who had duodenal ulcers, 95.7% (n = 452) were H. pylori-positive and only 1.69% (n = 8) were negative for both H. pylori infection and NSAID use; 193 patients had benign gastric ulcers and 87% (n = 168) of them were infected by H. pylori (p <.001 vs. duodenal ulcers). NSAID intake was more frequent in gastric ulcer patients (52.8%) than in duodenal ulcer patients (25.4%; p <.001). Consequently, the frequency of H. pylori-negative gastric ulcer in patients not using NSAID was 4.1% (n = 8).
  
  
  CONCLUSIONS
  Peptic ulcer disease is still highly associated with H. pylori infection in southern Europe, and only 1.6% of all duodenal ulcers and 4.1% of all gastric ulcers were not associated with either H. pylori infection or NSAID use.
authors.affiliation: Service of Gastroenterology, Hospital Clínico, Zaragoza, Spain.
authors.forename: M Teresa
authors.initials: MT
authors.lastname: Arroyo
authors.forename: Montse
authors.initials: M
authors.lastname: Forne
authors.forename: Carlos Martin
authors.initials: CM
authors.lastname: de Argila
authors.forename: Faust
authors.initials: F
authors.lastname: Feu
authors.forename: Juan
authors.initials: J
authors.lastname: Arenas
authors.forename: Juan
authors.initials: J
authors.lastname: de la Vega
authors.forename: Vicente
authors.initials: V
authors.lastname: Garrigues
authors.forename: Francisco
authors.initials: F
authors.lastname: Mora
authors.forename: Manuel
authors.initials: M
authors.lastname: Castro
authors.forename: Luis
authors.initials: L
authors.lastname: Bujanda
authors.forename: Angel
authors.initials: A
authors.lastname: Cosme
authors.forename: Agustín
authors.initials: A
authors.lastname: Castiella
authors.forename: Javier P
authors.initials: JP
authors.lastname: Gisbert
authors.forename: Antonio
authors.initials: A
authors.lastname: Hervas
authors.forename: Angel
authors.initials: A
authors.lastname: Lanas
mesh_terms: D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D005260:Female; D016481:Helicobacter Infections / Q000382:microbiology*; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D015995:Prevalence; D013030:Spain / Q000453:epidemiology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal