Clinical and endoscopic characteristics of non-Helicobacter pylori, non-NSAID duodenal ulcers:: a long-term prospective study

Background: The proportion of duodenal ulcers not associated with Helicobacter pylori infection or the use of non-steroidal anti-inflammatory drugs (NSAIDs) is increasing. Aim: To identify the clinical and endoscopic characteristics of non-H. pylori, non-NSAID duodenal ulcers. Methods: Clinical and endoscopic data and H. pylori status were prospectively collected from consecutive patients who underwent upper endoscopy from 1997 to 1999. Patients with duodenal ulcers were identified, and those with non-H. pylori, non-NSAID duodenal ulcers were analysed further. Results: A total of 11 717 upper endoscopies were performed in 8344 patients. Of these, 1153 (14%) had duodenal ulcers. Of 599 patients with active ulcers and known H. pylori status, 104 (17%) had ulcers not associated with H. pylori or the use of NSAIDs, 393 (66%) had ulcers associated with H. pylori alone, 51 (8.5%) had ulcers associated with the use of NSAIDs alone and 51 (8.5%) had ulcers associated with both. Multivariate logistic regression analysis revealed that the presence of concomitant diseases (odds ratio = 15.0; 95% confidence interval, 8.64- 25.9; P < 0.001) and the absence of epigastric pain/ discomfort (odds ratio = 0.52; 95% confidence interval, 0.29-0.91; P = 0.022) were independent predictors for non-H. pylori, non-NSAID duodenal ulcers. Conclusions: Non-H. pylori, non-NSAID duodenal ulcers exhibit certain distinct clinical and endoscopic characteristics. The presence of concomitant diseases is an important predictive factor.