title: Helicobacter pylori-negative and non-steroidal anti-inflammatory drugs-negative idiopathic peptic ulcers show refractoriness and high recurrence incidence: Multicenter follow-up study of peptic ulcers in Japan.
abstract: OBJECTIVE
  Helicobacter pylori-negative and non-steroidal anti-inflammatory drugs (NSAIDs)-negative idiopathic peptic ulcers (IPU) have attracted attention in Japan and other developed countries. The aim of the present study was to clarify the healing rate of IPU and the risk of recurrence.
  
  
  METHODS
  We conducted a retrospective follow-up study of patients with peptic ulcer disease (PUD) who were diagnosed in our previous multicenter-prospective study. Three hundred and eighty-two patients from four institutions in the Tohoku district were enrolled. Enrolled subjects were divided into four groups according to H. pylori infection and intake of NSAIDs. In these patients, we checked treatment course, healing rate during 3 months, and recurrence rate.
  
  
  RESULTS
  Healing rates in the: (i) simple H. pylori group; (ii) H. pylori (+)/ NSAIDs (+) group, (iii) simple NSAIDs group; and (iv) IPU group, were 95.0%, 94.9%, 73.3%, and 77.4%, respectively. The healing rate of the IPU group was significantly lower than that of both the simple H. pylori group and the H. pylori (+)/ NSAIDs (+) group (P < 0.01). The recurrence rate of 13.9% in the IPU group was much higher than the 2.1% in the simple H. pylori group (P < 0.01). Additionally, the cumulative recurrence rates by the Kaplan-Meier method in the IPU group were significantly higher than those of the simple H. pylori group (P = 0.015).
  
  
  CONCLUSIONS
  We demonstrated that the clinical course of peptic ulcers is considerably different depending on the cause. IPU could be refractory to treatment and prone to recur compared with simple H. pylori ulcers.
authors: Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Takeshi
authors: T
authors: Kanno
authors: Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.|Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan.
authors: Katsunori
authors: K
authors: Iijima
authors: Department of Gastroenterology, Yamagata University Faculty of Medicine, Yamagata, Japan.
authors: Yasuhiko
authors: Y
authors: Abe
authors: Department of Gastroenterology, Yamagata University Faculty of Medicine, Yamagata, Japan.
authors: Makoto
authors: M
authors: Yagi
authors: Department of Gastroenterology, South Miyagi Medical Center, Shibata-gun, Japan.
authors: Sho
authors: S
authors: Asonuma
authors: Department of Gastroenterology, Osaki Citizen Hospital, Osaki, Japan.
authors: Motoki
authors: M
authors: Ohyauchi
authors: Department of Gastroenterology, Osaki Citizen Hospital, Osaki, Japan.
authors: Hirotaka
authors: H
authors: Ito
authors: Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Tomoyuki
authors: T
authors: Koike
authors: Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Tooru
authors: T
authors: Shimosegawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D016480:Helicobacter pylori; D006801:Humans; D015994:Incidence; D007564:Japan; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000453:epidemiology*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Helicobacter pylori-negative; idiopathic peptic ulcer; non-steroidalantiinflammatory drugs-negative; recurrence; refractory