Peptic ulcer disease: one in five is related to neither Helicobacter pylori nor aspirin/NSAID intake.

BACKGROUND: The proportion (and even the reality) of peptic ulcer disease (PUD) not related to H. pylori or NSAID/aspirin is debated. AIM: To analyse the current epidemiological and clinical characteristics of peptic ulcer disease in French general hospitals. METHODS: Prospective multicentre study of patients with peptic ulcer disease in 32 French general hospitals over 1 year. H. pylori status was assessed by histology, and/or serology and/or C13-urea breath test. NSAID/aspirin intake (obtained by direct interview) and data about concomitant diseases were collected on the day of endoscopy. RESULTS: Nine hundred and thirty-three patients were selected during the year 2009. After exclusion of 118 patients with only erosive duodenitis, 24 with major missing data, 13 with other causes of ulcer and 65 negative for H. pylori by only one test, 713 patients were classified into four groups: 285 (40.0%) had only H. pylori infection; 133 (18.7%) only gastrotoxic drugs; 141 (19.8%) had both and 154 (21.6%) neither H. pylori infection nor gastrotoxic drug intake ('idiopathic ulcers'). Patients with idiopathic ulcers differed in many ways both from H. pylori and NSAID/aspirin groups. However, multivariate analysis identified only three independent predictors: age, French metropolitan origin and the presence of comorbidities. CONCLUSION: In a general hospital-based population in France, peptic ulcer disease appears idiopathic in a fifth of cases.

[Does the finding of a bilious mucous lake during endoscopy have physiopathological significance? Study of gastric pH during 24 hours]. / La constatation d'un lac muqueux bilieux en endoscopie a-t-elle une signification physiopathologique? Etude du pH gastrique pendant 24 heures.

The aim of this study was to determine if there was any relationship between the presence of bile in the stomach at endoscopy and the nycterohemeral variations of the gastric pH. Endoscopy and 24 hour gastric pH monitoring with radiotele-pHmetry were performed in 38 patients. These patients were then divided into two groups according to the color of the mucous lake at endoscopy: group A (15 patients) in which there was a clear mucous lake and group B (23 patients) in which a bilious mucous lake was found. In group A, spontaneous alkalinizations (SA) were uncommon and almost always lasted less than 30 min. In group B, SA were more frequent and more prolonged (p less than 0.01), especially those lasting more than 30 min (p less than 0.001). In this group, the number and duration of SA were significantly higher during the night. These results suggest that duodenogastric reflux may be responsible for the SA observed in patients with a bilious mucous lake. This hypothesis, however, needs further confirmation especially concerning the analysis of the gastric contents during the periods of alkalinization.