Study of helicobacter pylori negative, non-steroidal anti-inflammatory drug-negative peptic ulcers in a tertiary care center

 

 

Abstract              Background: H. pylori, aspirin, and other non-steroidal anti-inflammatory drugs (NSAIDs) comprise the causes of a large proportion of peptic ulcers. H. pylori-negative, NSAID-negative, and aspirin-negative peptic ulcer disease, are increasing nowadays. While this rise in H. pylori-negative, NSAID-negative ulcer rates reflects a relative increase accompanying a decline in H. pylori-positive ulcers due to the increased use of bacterial elimination therapy or decline of H. pylori infection rate among background healthy population, yearly data also suggest that the actual number of such ulcer patients is increasing. Present study was aimed to study Helicobacter pylori negative, non-steroidal anti-inflammatory drug-negative peptic ulcers at our tertiary care center. Material and Methods: Present prospective, observational study was conducted department of Gastroenterology in patients more than 18 years age with at least one site of active gastric or duodenal ulcer detected during endoscopy. Results: After applying inclusion and exclusion criteria, 260 patients diagnosed with peptic ulcer disease were considered for present study. Men (68 %) outnumbered women (32 %). Male to female ratio was 2.1 :1. Most common age group was 41-50 years (37 %) followed by 51-60 years (26 %). Mean age was 51 ± 13.9 years in present study. We noted smoking (18%), alcohol abuse (15%), opioid abuser (2%) in present study. In present study incidence of duodenal ulcers (61 %) was more than gastric ulcers (39 %). Compared to urea breath test, rapid urease test had a sensitivity of 89.1% and a specificity of 78.9%. 169 (65 %) patients tested positive by at least one of the tests and were considered to be infected with H. pylori. 91 (35 %) patients with rapid urease test (RUT) and urea breath test (UBT) negative, 37 (41%) had gastric ulcer and 54 (59%) had duodenal ulcer (p-0.041, statistically significant). Patients with both rapid urease test (RUT) and urea breath test (UBT) test negative were comparable in terms age, gender, and presence of risk factors, like smoking and alcoholism with those who tested positive with either rapid urease test (RUT) and/or urea breath test (UBT). Conclusion: Increasing incidence of H. pylori-negative, NSAID-negative, and aspirin-negative peptic ulcer disease is noted as compared to past.

Key Words: peptic ulcer disease, Helicobacter pylori; Non-steroidal anti-inflammatory drugs, Helicobacter pylori negative.