Background and aim: The prevalence of Helicobacter pylori-negative duodenal ulcer (DU) is increasing in Western countries but is rare in Japan. We aimed to examine the prevalence of H. pylori infection and the characteristics in DU and gastro-duodenal ulcer (GDU) diseases in Taiwan.
Study: All patients with an endoscopic diagnosis of DU or GDU from September 2003 to May 2004 at Taipei Veterans General Hospital were included. Rapid urease test was done for all patients, while urea breath test was carried out on those with negative rapid urease tests. A patient was considered infected if either test was positive.
Results: The prevalence of H. pylori was 88.7% (555/626) in DU and 90.5% (95/105) in GDU patients. There was no difference in sex and prevalence of H. pylori between the two groups but age was higher in the GDU patients (60.1 +/- 15.5 vs. 55.4 +/- 15.5, P = 0.005). Of H. pylori-negative DU patients, 28.2% (20/71) reported using non-steroidal anti-inflammatory drugs (NSAIDs)/aspirin, which were used by all 10 H. pylori-negative GDU patients (100%) (P < 0.001). There was no difference in sex and age between H. pylori-positive and negative DU patients. The prevalence rate of H. pylori in DU was not statistically different among outpatients, inpatients, and physical check-up subjects (86.8% vs. 93.3% vs. 90.7%, P = 0.163).
Conclusion: The prevalence of H. pylori infection in DU appears to be decreasing in Taiwan. Thus, eradication therapy without confirming the presence of H. pylori in DU patients cannot be recommended. NSAIDs/aspirin is the major risk factor for H. pylori-negative DU patients, especially those with co-morbid gastric ulcer.