title: Nonsteroidal anti-inflammatory drug use is a significant cause of peptic ulcer disease in a tertiary hospital in Singapore: a prospective study.
abstract: BACKGROUND
  Peptic ulcers due to nonsteroidal anti-inflammatory drug (NSAID) use may have contributed to the static prevalence of ulcer disease in Asia.
  
  
  OBJECTIVE
  We aimed to determine the current etiology of peptic ulcer disease in Singapore.
  
  
  METHODS
  Consecutive patients undergoing esophagogastroduodenoscopy who had not been exposed to antibiotics, or antiulcer therapy within the past 6 months, and in whom peptic ulcers were found, were prospectively studied. Before endoscopy, patients were interviewed regarding the use of NSAID or aspirin. During endoscopy, antral biopsies were obtained for urease test and histology. Serum thromboxane B2 levels were compared with those of healthy volunteers.
  
  
  RESULTS
  Peptic ulcers were detected in 600 patients during a 2-year period. The ulcers were negative for Helicobacter pylori in 212 patients (35.3%) and these H. pylori negative ulcers were related to NSAID use in 68.9% of cases. On the basis of serum thromboxane B2 levels, 30.8% of the patients with non-H. pylori non-NSAID were considered to have consumed NSAID.
  
  
  CONCLUSIONS
  H. pylori negative peptic ulcer makes up a significant proportion of peptic ulcer in Singapore. Most of these ulcers were related to NSAID use. Serum thromboxane profile suggested surreptitious NSAID use in many of the non-H. pylori and apparently non-NSAID patients.
authors.affiliation: Department of Gastroenterology and Hepatology, National University Hospital, Singapore Wolfson Digestive Diseases Centre, University Hospital Nottingham, UK.
authors.forename: Tze-Zen
authors.initials: TZ
authors.lastname: Ong
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Hawkey
authors.forename: Khek-Yu
authors.initials: KY
authors.lastname: Ho
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D005260:Female; D005755:Gastrins / Q000097:blood; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000097:blood / Q000139:chemically induced* / Q000382:microbiology; D011446:Prospective Studies; D012846:Singapore; D013929:Thromboxane B2 / Q000097:blood
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005755:Gastrins; D013929:Thromboxane B2