Prevalence of Helicobacter pylori Infection in Patients with Peptic Ulcer Diseases and Non-Ulcer Dyspepsia

BACKGROUND: Helicobacter pylori is known to be a cause of active chronic gastritis and has been proposed as an etiologic factor in the development of peptic ulcer disease, but controversy continues regarding the pathogenic importance and mechanism. We examined the prevalence of H. pylori infection in patients with peptic ulcers and non-ulcer dyspepsia. METHOD: 749 patients (373 with duodenal ulcer, 303 with gastric ulcer, 73 with non-ulcer dyspepsia) were included. Endoscopic mucosal biopsies were done at antrum, duodenum, and, if present, ulcer margin. The specimens were tested by Gram staining, Giemsa staining, culture, urease testing for identification of H. pylori. Antibody to H. pylori was examined in 83 patient of these patients by ELISA, and the result was compared with the results of bacteriologic studies. RESULT: Prevalence of H. pylori in antral mucosa was higher in patients with duodenal ulcers (81.5%) than in patients with gastric ulcer and non-ulcer dyspepsia (56% and 52.8%) (P<0.05). Also in the duodenal mucosa of non-ulcer sites, and the ulcer margin of patients with duodenal ulcers, the detection rates (12% and 40.7%) were higher than those in the duodenal mucosa of patients with gastric ulcer and non-ulcer dyspepsia (7% and 8%)(p<0.005). Antibody to H. pylori was detected in all patients with duodenal and gastric ulcers and non-ulcer dyspepsia who were tested for antibody. In contrast, the detection rates of antibody in adult control and child control were 33.3% and 27%. Among patients with antibody to H. pylori, H. pylori was detected in 85.7% of patients with duodenal ulcer, 62.5% of patients with gastric ulcers and 22.2% of patients with non-ulcer dyspepsia(p<0.05). CONCLUSION: These data suggest that H. pylori is a possible pathogen for duodenal ulcer by duodenal colonization probably via gastric metaplasia. Also the past or present infection of H. pylori in antral mucosa may play a role at least partially in generation of upper gastrointestinal symptoms.