Characteristics of Helicobacter pylori-negative and -positive peptic ulcer disease

To examine histological and other features of patients with Helicobacter pylori-positive (HP+) and -negative (HP-) peptic ulcers and characterize typical features of peptic ulcer in elderly patients.

137 consecutive patients with peptic ulcer and 70 patients with dyspepsia were studied over 24 months. Endoscopy and a structured personal interview were carried out in all patients. Three histological specimens were obtained from the antral mucosa.

The mean age of ulcer patients was 62.4 (SD 15.7) years and that of dyspepsia patients was 56.9 (SD 18.1) years (P=0.026). Of patients with HP- ulcers, 80.6% were aged 65 years or over; the corresponding proportion of patients with HP+ ulcer was 33.7% (P=0.0001). The use of non-steroidal anti-inflammatory analgesics was more common among those whose ulcer was HP- (69.4% vs 33%, P=0.0002). The occurrence of antral inflammation, atrophy and intestinal metaplasia did not differ between those with HP- and HP+ ulcers, but activity of gastritis was more common in HP+ than in HP- patients (94.9% vs 47.1%, P=0.0001). In the logistic regression analysis, HP- peptic ulcer disease was independently associated with older age, bile reflux, the use of non-steroidal anti-inflammatory analgesics and intestinal metaplasia, while HP+ ulcer disease was associated with active inflammation of the antral mucosa and tendency to ulcer recurrence.

HP+ and HP- peptic ulcers have well-defined characteristics which probably reflect their different pathogenesis. Peptic ulcer disease of elderly people is mostly HP-.