Peptic Ulcer Disease
Peptic Ulcer Disease
Nine hundred and thirty-three patients were initially included (Figure 1). Two hundred and twenty patients were secondarily excluded, 4 because ulcer status was missing, 12 because of malignant disease (adenocarcinoma, lymphoma or GIST), and 20 as H. pylori status and/or ulcerogenic drug intake was not reported, 118 patients with erosive duodenitis alone, three patients with other specific diagnoses (Crohn's disease one case, coeliac disease one case, and H. heilmanii infection one case), two of them belonging to the duodenitis only group, leaving 778 patients. Finally 65 patients were excluded from this analysis because they were negative for H.pylori with only one diagnostic test, leaving 713 patients as the final study population (Figure 1).
(Enlarge Image)
Figure 1.
Flow-chart of selected patients. NSAIDs, nonsteroidal anti-inflammatory drugs; LDA, low dose aspirin; HDA, high dose aspirin.
There were 413 male patients (57.9%), mean age was 61.8 years (18–100 years). Most patients (74.4%) were born in metropolitan France. Gastric ulcer was observed in 41.7% of the patients, duodenal ulcer in 54.8% and both gastric and duodenal ulcer in 3.4%. Endoscopy was performed for epigastric pain in 303 (42.5%) patients, chronic anaemia in 151 (21.2%) patients, haemorrhage in 261 (36.6%) patients and for other indications in 98 (13.7%) cases. One hundred and fifty (21.0%) patients took preventive PPIs, paradoxically more often before than after 65 years of age (21.0% vs. 14.3%, P = 0.006). One hundred and eight patients (15.1%) had taken antibiotics prior to the endoscopic period, more often in Hp-negative (55/287, 19.2%) than in Hp-positive patients (51/426, 12.0%), P = 0.008).
For H. pylori diagnosis, gastric biopsies were obtained in 686 (96.2%) patients, serology in 649 (91.0%) patients, an C urea breath test in 38 (5.3%) patients. A past history of ulcer was found in 132 patients (18.5%), 88 (66.7%) being H. pylori-positive, and a previous attempted eradication treatment in 33 (4.6%). Four hundred and twenty-six patients (59.7%) were H. pylori-positive.
Two hundred and seventy-four patients (38.4%) took aspirin or NSAIDs (Figure 1). One hundred and twenty-six patients (46.0%) were on low dose aspirin (LDA), mainly alone (88.1%) and 148 (54.0%) took NSAIDs, high dose aspirin (HDA), or coxib. Only 32/165 (19.4%) patients of more than 64 years of age taking NSAIDs received preventive PPIs.
Two hundred and eighty-five patients (40.0%) with only H. pylori infection were called 'H. pylori-associated PUD'; 133 (18.7%) patients with only gastrotoxic medications were called 'NSAID/aspirin-associated PUD'; 141 (19.8%) patients with both risk factors were called 'H. pylori/NSAID/aspirin-associated PUD' and 154 (21.6%) patients without risk factor were called 'idiopathic PUD' (Table 1).
H. pylori-associated PUD patients were younger, less often born in metropolitan France, more often of male gender, had more often past ulcer history pain and less often haemorrhage at presentation, more duodenal than gastric ulcers and low death rate.
NSAID/aspirin-associated PUD were older, more often born in metropolitan France, more often of female gender, had less often a past history of ulcer, more haemorrhage at presentation, more gastric than duodenal ulcers and a higher death rate.
H. pylori/NSAID/aspirin-associated PUD patients had intermediate, mixed characteristics of H. pylori-associated PUD and NSAID/aspirin-associated PUD patients.
Idiopathic PUD patients differed from both H. pylori-associated PUD and NSAID/aspirin-associated PUD (Table 1 and Table 2). The main differences with H. pylori-associated PUD were older age, a near-equal sex- ratio, a six times more frequent origin from the French metropolitan region, a more severe clinical presentation, a two times more frequent comorbidity. The main differences with NSAID/aspirin-associated PUD were a slightly lower age (P = 0.02), less severe presentation, a lower death rate, different ulcer site (more duodenal and less gastric ulcers), and 1.6 times more frequent comorbidities (Table 1 and Table 2).
Logistic regression analysis showed that age, French metropolitan origin and the presence of comorbidities were the only independent predictors of idiopathic ulcers (Table 3); the percentage of explained variance was 17.0 percent.
Histological reports of patients with idiopathic ulcers were reviewed by an experienced gastrointestinal pathologist. Mucosa was considered normal in 41 cases (26.6%), intestinal metaplasia was found in three cases (limited to the antrum in two cases and diffuse in one case); there was a reactive gastropathy (characterised by congestion, oedema, loose plasma cells infiltrate without polymorphonuclear neutrophils) in all the remaining cases. In all the cases, the histological abnormalities were graded as mild or minor.
Results
Nine hundred and thirty-three patients were initially included (Figure 1). Two hundred and twenty patients were secondarily excluded, 4 because ulcer status was missing, 12 because of malignant disease (adenocarcinoma, lymphoma or GIST), and 20 as H. pylori status and/or ulcerogenic drug intake was not reported, 118 patients with erosive duodenitis alone, three patients with other specific diagnoses (Crohn's disease one case, coeliac disease one case, and H. heilmanii infection one case), two of them belonging to the duodenitis only group, leaving 778 patients. Finally 65 patients were excluded from this analysis because they were negative for H.pylori with only one diagnostic test, leaving 713 patients as the final study population (Figure 1).
(Enlarge Image)
Figure 1.
Flow-chart of selected patients. NSAIDs, nonsteroidal anti-inflammatory drugs; LDA, low dose aspirin; HDA, high dose aspirin.
There were 413 male patients (57.9%), mean age was 61.8 years (18–100 years). Most patients (74.4%) were born in metropolitan France. Gastric ulcer was observed in 41.7% of the patients, duodenal ulcer in 54.8% and both gastric and duodenal ulcer in 3.4%. Endoscopy was performed for epigastric pain in 303 (42.5%) patients, chronic anaemia in 151 (21.2%) patients, haemorrhage in 261 (36.6%) patients and for other indications in 98 (13.7%) cases. One hundred and fifty (21.0%) patients took preventive PPIs, paradoxically more often before than after 65 years of age (21.0% vs. 14.3%, P = 0.006). One hundred and eight patients (15.1%) had taken antibiotics prior to the endoscopic period, more often in Hp-negative (55/287, 19.2%) than in Hp-positive patients (51/426, 12.0%), P = 0.008).
For H. pylori diagnosis, gastric biopsies were obtained in 686 (96.2%) patients, serology in 649 (91.0%) patients, an C urea breath test in 38 (5.3%) patients. A past history of ulcer was found in 132 patients (18.5%), 88 (66.7%) being H. pylori-positive, and a previous attempted eradication treatment in 33 (4.6%). Four hundred and twenty-six patients (59.7%) were H. pylori-positive.
Two hundred and seventy-four patients (38.4%) took aspirin or NSAIDs (Figure 1). One hundred and twenty-six patients (46.0%) were on low dose aspirin (LDA), mainly alone (88.1%) and 148 (54.0%) took NSAIDs, high dose aspirin (HDA), or coxib. Only 32/165 (19.4%) patients of more than 64 years of age taking NSAIDs received preventive PPIs.
Two hundred and eighty-five patients (40.0%) with only H. pylori infection were called 'H. pylori-associated PUD'; 133 (18.7%) patients with only gastrotoxic medications were called 'NSAID/aspirin-associated PUD'; 141 (19.8%) patients with both risk factors were called 'H. pylori/NSAID/aspirin-associated PUD' and 154 (21.6%) patients without risk factor were called 'idiopathic PUD' (Table 1).
H. pylori-associated PUD patients were younger, less often born in metropolitan France, more often of male gender, had more often past ulcer history pain and less often haemorrhage at presentation, more duodenal than gastric ulcers and low death rate.
NSAID/aspirin-associated PUD were older, more often born in metropolitan France, more often of female gender, had less often a past history of ulcer, more haemorrhage at presentation, more gastric than duodenal ulcers and a higher death rate.
H. pylori/NSAID/aspirin-associated PUD patients had intermediate, mixed characteristics of H. pylori-associated PUD and NSAID/aspirin-associated PUD patients.
Idiopathic PUD patients differed from both H. pylori-associated PUD and NSAID/aspirin-associated PUD (Table 1 and Table 2). The main differences with H. pylori-associated PUD were older age, a near-equal sex- ratio, a six times more frequent origin from the French metropolitan region, a more severe clinical presentation, a two times more frequent comorbidity. The main differences with NSAID/aspirin-associated PUD were a slightly lower age (P = 0.02), less severe presentation, a lower death rate, different ulcer site (more duodenal and less gastric ulcers), and 1.6 times more frequent comorbidities (Table 1 and Table 2).
Logistic regression analysis showed that age, French metropolitan origin and the presence of comorbidities were the only independent predictors of idiopathic ulcers (Table 3); the percentage of explained variance was 17.0 percent.
Histological reports of patients with idiopathic ulcers were reviewed by an experienced gastrointestinal pathologist. Mucosa was considered normal in 41 cases (26.6%), intestinal metaplasia was found in three cases (limited to the antrum in two cases and diffuse in one case); there was a reactive gastropathy (characterised by congestion, oedema, loose plasma cells infiltrate without polymorphonuclear neutrophils) in all the remaining cases. In all the cases, the histological abnormalities were graded as mild or minor.
