To evaluate whether some duodenal ulcers (DU) classified as idiopathic according to standard criteria may be causally related to isolated duodenal colonization by H. pylori.
We studied consecutive ambulatory patients undergoing upper gastrointestinal endoscopy in a secondary care setting. Gastric and duodenal biopsies for diagnosing H. pylori infection were taken from all patients. Independently from the findings of duodenal biopsies, DU patients without gastric infection were classified as having idiopathic ulcers, and underwent urea C13 breath test and subsequent eradication therapy. Endoscopy was repeated 6 months after eradication treatment.
Among 608 DU patients, 42 (6.9%) were classified as idiopathic: 24 (3.9%) were free from gastric and duodenal infection (group A) and 18 (3.0%) (group B) had isolated duodenal colonization. Urea C13 breath test was positive in one (4.2%) group A patient and in 3 (16.7%) group B patients. After eradication therapy, DU were detected in 14 out of 20 group A patients (70%) (four patients did not perform control endoscopy) and in 2 group B patients (11.1%): OR 18.66, 95% CI 3.23–107.82, P= 0.002. The difference was still detectable after multivariate analysis taking into account possible confounding factors: OR 15.79, 95% CI 2.48–100.53, P= 0.001.
Isolated duodenal colonization by H. pylori is detectable in a substantial proportion of patients with so-called idiopathic DU, and eradication therapy is effective in these patients.
1Department of Biopathology-Occupational Medicine, 2Department of Surgery, and 3Department of Internal Medicine, Tor Vergata University, Rome, Italy
Reprint requests and correspondence: Antonio Pietroiusti, M.D., Department of Biopathology, Tor Vergata University, Via Montpellier 1, 00161 Rome, Italy.
Received February 27, 2007; accepted July 3, 2007.
CONFLICT OF INTERESTGuarantor of the article: Antonio Pietroiusti, M.D.
Specific author contributions: Antonio Pietroiusti ideated the study, was responsible for study design, reviewed the literature, and wrote the paper.
Antonio Forlini performed endoscopic examinations, collected endoscopic data, and contributed to the design of the study.
Andrea Magrini ideated and administered all questionnaires used in the study, collected their data, and analyzed all the data of the study.
Alberto Galante helped in the design of the study and contributed to the discussion of the results.
Antonio Bergamaschi was involved in discussion around the idea of this study. He reviewed the data analysis and contributed to the paper by critical comments and suggestions.
Financial support: This work was supported by a grant from Tor Vergata University (Fondi Ateneo 60% 2002). The funding source had no role at any stage in the preparation and management of the manuscript.
Potential competing interests: None.