title: Gastric Cancer and Gastrointestinal Stromal Tumors Could be Causes of non-Helicobacter Pylori non-NSAIDs Peptic Ulcers in Thailand
abstract: Background and aim: H. pylori and nonsteroidal anti-inflammatory drugs (NSAIDs) remain the major causes of
  peptic ulcer disease. Nevertheless, non- H. pylori non-NSAIDs peptic ulcers or idiopathic peptic ulcer disease (IPUD)
  constitute a growing problem associated with many complications. Gastric cancer and gastrointestinal stromal tumor
  (GIST) have also been reported as a cause of IPUD. This study was aimed to investigate prevalence and clinical
  characteristics of IPUD in Thailand. Materials and Methods: Clinical information, histological features, endoscopic
  findings, history of H. pylori status and NSAIDs usage were collected for patients diagnosed with PUD in Thammasat
  University Hospital during January 2003 – December 2013. Results: Total of 1,310 patients was diagnosed with PUD
  in our institution during the study period, of which 71 (5.4%) had a definitive diagnosis of IPUD (45 men and 26
  women, mean age of 59±16.5 years). Common locations were gastric antrum (43.7%), duodenum (25.3%) and gastric
  body (12.7%). Common causes of IPUD were idiopathic (43.7%) and alcohol consumption (39.4%). Gastric cancer
  and GIST were also demonstrated in 1(1.4%) and 1(1.4%) respectively. Major complications were upper GI bleeding
  (73.2%) and peptic perforation (2.8%). Recurrent upper GI bleeding was detected in 23.9%. Interestingly, male patients
  aged<50 years with alcohol related peptic ulcer were significantly more common than female patients aged ≥ 50 years
  (57.8% vs 7.7%;P-value= 0.00002, OR= 16.4, 95%CI= 3.5-78 and 68.4% vs 28.9%); P-value= 0.002, OR= 5.3, 95%
  CI= 1.7-16.7). Conclusion: Common causes of IPUD in Thailand are idiopathic followed by alcohol consumption and
  steroid usage. Gastric cancer and GIST are also possible causes of IPUD. These particular ulcers had a high likelihood
  of developing severe complications. Appropriate screening and high level of suspicion of fatal causes eg. gastric cancer
  and GIST should be appropriate ways to reduce complications and improve the treatment outcome.
authors.affiliation: Gastroenterology Unit, Thammasat University Hospital, Bangkok Medical Center, Bangkok, Thailand. Email:Vilaichone@hotmail.co.th
authors.forename: Pattama
authors.initials: P
authors.lastname: Kiatpapan
authors.forename: Ratha korn
authors.initials: RK
authors.lastname: Vilaichone
authors.forename: Peranart
authors.initials: P
authors.lastname: Chotivitayatarakorn
authors.forename: Varocha
authors.initials: V
authors.lastname: Mahachai
keywords: Gastric cancer; non w; non-NSAIDs peptic ulcer; Thailand