Achlorhydria does not protect against benign upper gastrointestinal ulcers during NSAID use

It is widely accepted that the absence of acid-peptic activity excludes the presence of a benign upper gastrointestinal ulcer. We assessed the frequency of a history of benign upper gastrointestinal ulcer disease in patients with and without serological evidence of achlorhydria with reference to the use of nonsteroidal antiinflammatory drugs (NSAIDs). In total 857 patients were interviewed, using a standard questionnaire with emphasis on demographic data, chronic use of NSAID, and history of upper gastrointestinal ulcers. The frequency of achlorhydria was determined by extremely low serum levels of pepsinogen A (PgA < 17 micrograms/liter). Of the total group of patients, 36 patients (4.2%; 95% CI 2.9-5.5) had a PgA lower than 17 micrograms/liter. A history of benign upper gastrointestinal ulcer was found in 57/827 (6.9%) of patients with serum PgA higher than 17 micrograms/liter and in 3/36 (8.3%) of patients with serum PgA lower than 17 micrograms/liter (NS). The three patients with upper gastrointestinal ulcer and PgA lower than 17 micrograms/liter were known to have pernicious anemia (PA) before (two patients) or simultaneously (one patient) with the diagnosis of the upper gastrointestinal ulcer and were using NSAIDs at that time. The presence of gastric acid is not obligatory for the development of ulcers during NSAID use.