Helicobacter pylori in duodenal ulcer patients with idiopathic gastric acid hypersecretion

Thirty-three consecutive patients with idiopathic gastric acid hypersecretion (defined as a basal acid output >10.0 meq/hr with a normal fasting serum gastrin level and negative secretin stimulation test) who were being treated for duodenal ulcer disease and other acid-peptic disorders were evaluated for the presence ofHelicobacter pylori by means of a rapid urease test. Fourteen patients had duodenal ulcer and 19 had other acid-peptic disorders (gastroesophageal reflux in 14, including six with Barrett's esophagus; four with nonulcer dyspepsia; and one with erosive gastritis).Helicobacter pylori was present in 12 of the 14 ulcer patients (86%) compared to only two of the 19 nonulcer patients (11%) (P<0.0001). The distribution of basal acid output for patients with duodenal ulcer was similar to that for nonulcer patients, and no significant difference in the mean basal acid output was found amongHelicobacter pylori-positive compared toHelicobacter pylori-negative patients. Seven of the duodenal ulcer patients with a basal acid output greater than 15.0 meq/hr wereHelicobacter pylori-positive, suggesting that the organism can withstand even extreme levels of gastric acidity. In conclusion, this study demonstrates that the prevalence ofHelicobacter pylori infection in patients with duodenal ulcer disease associated with idiopathic gastric acid hypersecretion is not different from a majority of ulcer patients with normal acid secretory profiles and offers additional evidence that extreme levels of gastric acid are not bactericidal for the organism.     

Prevalence of gastric metaplasia in the duodenal bulb is low in Helicobacter pylori positive non-ulcer dyspepsia patients

Background. Gastric metaplasia in duodenum is a common phenomena in duodenal ulcer patients. However, the role of gastric metaplasia in patients with non-ulcer dyspepsia is not clear. It is not known either, whether Helicobacter pylori infected non-ulcer patients who are CagA-seropositive have gastric metaplasia in duodenum more often than CagA-negative patients.Aims. To compare prevalence of gastric metaplasia in duodenum in non-ulcer dyspepsia patients according to Helicobacter pylori status.Patients and methods. A series of 400 unselected dyspeptic patients in primary care were investigated. Patients with no endoscopic evidence of organic disease (n=236) were enrolled in the study. Duodenal bulb and gastric biopsies were collected, as well as blood samples for Helicobacter pylori determination.Results. There were no differences between CagA-seropositive and -seronegative Helicobacter pylori infected patients as far as concerns gastric metaplasia in duodenal bulb (20% vs 25%). Helicobacter pylori negative non-ulcer patients more often had gastric metaplastic changes (46%, p<0.0001) in duodenum.Conclusion. Helicobacter pylori infection has no major role in development of gastric metaplasia in duodenal bulb in non-ulcer dyspeptic patients. Furthermore, it does not result in positive CagA-serology, an increased risk for gastric metaplasia compared with CagA-seronegative cases.     

Distribution of Helicobacter pylori virulence markers in patients with gastroduodenal diseases in Pakistan

Background  

Helicobacter pylori (H. pylori) infection is known to be associated with a spectrum of gastroduodenal diseases. We studied the association of H. pylori virulence markers cytotoxin-associated gene (cagA) and vacuolating associated cytotoxin gene (vacA) alleles in patients with non ulcer dyspepsia (NUD), gastric ulcer (GU), gastric carcinoma (GC) and duodenal ulcer (DU).     

Assessment of symptomatic response as predictor of Helicobacter pylori status following eradication therapy in patients with ulcer

Background—Helicobacter pylorieradication therapy is routinely used for treating patients with pepticulcer disease.
Aims—To assess the value of symptomatic responseto H pylori eradication therapy as a marker ofpost-treatment H pylori status.
Patients and methods—One hundred and ninedyspeptic patients with active duodenal or gastric ulcerationassociated with H pylori infection had their symptomsmeasured by a validated questionnaire before and three months followingH pylori eradication therapy. The symptomatic response wascompared with post-treatment H pylori status as determinedby the ¹⁴C urea breath test.
Results—An eradication rate of 84% was achieved.Of the 92 patients eradicated of H pylori, 47%experienced complete or near complete resolution of dyspepsia. Of the17 patients in whom the infection was not eradicated, only one (6%)experienced resolution of dyspepsia. Resolution of dyspepsia wastherefore a powerful predictor of eradication of H pyloriwith a predictive value of 98%. In contrast, persistence of dyspepsiawas a weak predictor of persisting infection with a predictive value ofonly 25%. Excluding patients with endoscopic evidence of coexistingoesophagitis and/or retrosternal discomfort or reflux at initialpresentation did not increase the predictive value of persistingdyspepsia for persisting infection.
Conclusions—Complete resolution of dyspepticsymptoms is a powerful predictor of eradication of Hpylori infection in ulcer patients. Persistence of symptoms is aweak predictor of persisting infection and patients with persistingdyspepsia must have their H pylori status rechecked toguide future management.

Keywords:Helicobacter pylori; dyspepsia; ulcerdisease; eradication therapy; reflux disease

     

The personality patterns in patients with duodenal ulcer and ulcer-like dyspepsia and their relationship to the course of the diseases

Abstract. Objectives. To compare personality characteristics in duodenal ulcer patients and patients with ulcer-like dyspepsia from the primary health sector with duodenal ulcer patients from a hospital and to evaluate the relationship of the personality characteristics to the course of the diseases. Design. A prospective study using the Minnesota Multiphasic Personality Inventory (MMPI) with retesting of a subgroup of patients after a median observation period of 14 months. Setting. Departments of Medical and Surgical Gastroenterology, Hvidovre University Hospital, and the primary health sector in Roskilde County, Denmark. Subjects. Sixty hospital patients with duodenal ulceration and 17 patients with duodenal ulceration plus 2 5 patients with ulcer-like dyspepsia from the primary health sector. Main outcome measures. MMPI scores. Results. The hospital patients differed from the two other groups of patients by having higher scores of depression and anxiety (P < 0.05). Twenty-eight of the patients were retested with MMPI. Contrary to the patients with persisting complaints, abnormal personality characteristics disappeared in patients without complaints (P < 0.05-0.001). Conclusions. The results indicate that abnormal personality characteristics in patients with functional and organic upper dyspepsia are consequential rather than causal factors.     

Symptom clusters cannot be used in distinguishing Helicobacter pylori positive or negative patients with functional dyspepsia

Background: A retrospective study was done in consecutive patients in order to seek out whether dyspepsia subgroups (reflux-like, ulcer-like, and, dysmotility-like dyspepsia) can be useful in describing Helicobacter pylori positive and negative functional dyspepsia.Methods: Consecutive patients who underwent upper gastrointestinal endoscopy were included if no macroscopic lesions in oesophagus, stomach or duodenum were seen. Antral biopsy specimens were taken for detection of H. pylori. A validated questionnaire was used. Results: Six hundred patients fulfilled the inclusion criteria. Three hundred were positive for H. pylori. In the H. pylori positive (HP+) patients only 3 (1.2%) had `pure' reflux-like dyspepsia, 17 (6.9%) had ulcer-like dyspepsia and 10 (4%) suffered from dysmotility-like dyspepsia. In the H. pylori negative (HP−) patients these figures were 6 (2.3%), 17 (6.6%) and 7 (2.7%), respectively (ns). The majority of patients had a combination of complaints belonging to the three subgroups. Reflux-like dyspepsia was present in 179 (73%) HP+ dyspeptics and 195 (76%) HP−'s (ns). Ulcer-like dyspepsia was present in 213 (88%) HP+ cases and 233 (92%) HP−'s (ns). Dysmotility-like dyspepsia was present in 197 (81%) HP+'s and 212 (82%) HP−'s (ns).Conclusions: It is concluded that it is not possible to identify patients suffering from H. pylori infection on basis of symptom clusters.     

Conceivable mechanisms by which Helicobacter pylori provokes duodenal ulcer disease

A conceivable concept for the development of duodenal ulcers in Helicobacter pylori(H. pylori) infected subjects is presented in this chapter. The concept includes an explanation of the fact that only a minority of all H. pylori -infected subjects will develop a duodenal ulcer. Helicobacter pylori infection of the antrum induces a hypersecretion of gastric acid secretion, giving rise to gastric metaplasia in the duodenal bulb. This gastric metaplasia is a prerequisite for H. pylori colonization of the bulb. These events are common to all H. pylori -infected subjects. However, a much higher density of H. pylori bacteria and colonization with virulent organisms has been found in the bulb of duodenal ulcer patients, resulting in a much stronger inflammatory reaction with active duodenitis and an impaired bicarbonate secretion. These characteristics, together with acid hypersecretion, seem to be the important factors in evoking a duodenal ulcer.     

Link betweenHelicobacter pylori-associated gastritis and duodenal ulcer

We examined the interrelationships among the degree of fundic mucosal atrophy, the prevalence ofHelicobacter pylori in the gastric antrum, the gastric juice, and the duodenum with and without gastric metaplasia, in 20 duodenal ulcer patients and 20 non-duodenal ulcer patients. The detection rates ofH. pylori in the antrum, the gastric juice, and the duodenum were significantly higher in duodenal ulcer patients (80%, 65%, and 60%) than in non-duodenal ulcer subjects (50%, 20%, and 5%). The frequency ofH. pylori was significantly lower in the gastric juice (30%) and the duodenum (10%) in non-duodenal ulcer patients with antralH. pylori, compared with those in duodenal ulcer patients with antralH. pylori. All of seven patients with both gastric metaplasia andH. pylori infection in the duodenum had duodenal ulcer, whereas only 1 of 14 patients without either gastric metaplasia orH. pylori infection in the duodenum had duodenal ulcer. There was normal or mild atrophic mucosa in the fundus of duodenal ulcer patients withH. pylori in the antrum, whereas moderate or severe atrophic mucosa in non-duodenal ulcer patients withH. pylori gastritis. These results suggest that the preserved fundic mucosa, gastric metaplasia in the duodenum, and a greater load ofH. pylori to the duodenum through the gastric juice may be prerequisites for the formation of duodenal ulcers.     

Impairment of gastric secretion modulation in duodenal ulcer and in long-term PPI treatment: quantitative morphologic findings and pathophysiologic implications

Helicobacter pylori affects gastric secretion. This functional effect might have a morphometric counterpart. Therefore, the gastric cell secretory compartment was morphometrically assessed in different pathophysiologic conditions related to Helicobacter pylori infection. Nineteen Helicobacter pylori-positive nonduodenal ulcer subjects, 15 omeprazole chronically treated subjects, and 19 duodenal ulcer patients were studied against 19 controls. Somatostatin, gastrin, enterochromaffin-like, and parietal cell density was assessed in gastric biopsies. No differences in any cell type density were found between Helicobacter pylori-positive nonduodenal ulcer subjects and controls. On the contrary, differences were significant when comparing omeprazole and duodenal ulcer patients to controls (higher density of gastrin, enterochromaffin-like, and parietal cells, lower density of somatostatin cells). In duodenal ulcer a reversion to control values followed Helicobacter pylori eradication and ulcer healing. A direct linear correlation between enterochromaffin-like, gastrin, and parietal cell density was demonstrated. An almost complete map of mucosal cells involved in gastric secretion is provided by this study. The cell density pattern, identical to the omeprazole group, points to an impaired feedback control of secretion in duodenal ulcer. The reversion to control values after Helicobacter pylori eradication and ulcer healing demonstrates the pathogenetic role of Helicobacter pylori–host interaction in these changes.     

Helicobacter pylori and gastric acid output in peptic ulcer disease

Helicobacter pylori is associated with peptic ulcer, and a causal relationship has been postulated. We investigated the association betweenHelicobacter pylori and gastric acid output. Two hundred forty-one patients were studied: 173 with duodenal ulcer, 51 with gastric ulcer (41 corpus, 10 prepyloric), and 17 with combined gastric and duodenal ulcer. In 194 patients (80%),Helicobacter pylori could be demonstrated histologically from gastric antral biopsies. The presence or absence ofHelicobacter pylori was not influenced by age, sex, or use of tobacco or analgesics. Patients with duodenal ulcer or combined gastric and duodenal ulcer had similar gastric acid outputs irrespective of the presence or absence ofHelicobacter pylori. However, gastric ulcer patients withHelicobacter had higher basal and maximal acid outputs when compared to patients withoutHelicobacter (mean basal output: 4.1 mmol/hr vs 2.4,P<0.05; mean maximal output 19.5 mmol/hr vs 14.4,P<0.05). AlthoughHelicobacter pylori is associated with both gastric ulcer and duodenal ulcer, its significance may be different in the two diseases.     

Regression of duodenal gastric metaplasia in Helicobacter pylori positive patients with duodenal ulcer disease

Background. It is unclear whether the extent of duodenal gastric metaplasia is due to Helicobacter pylori and/or acid.Aims. To investigate the role of Helicobacter pylori eradication in the regression of duodenal gastric metaplasia in patients with duodenal ulcer maintained in acid suppression conditions.Methods. Duodenal (anterior, superior, inferior walls of first part of duodenum) and gastric antrum biopsies were obtained from 44 Helicobacter pylori positive duodenal ulcer patients. Helicobacter pylori infection was diagnosed by rapid urease test, histology and ¹³C-Urea Breath Test. Patients were treated with 20 mg omeprazole tid associated with 250 mg clarithromycin and 500 mg amoxycillin four times daily for 10 days and maintained with 20 mg omeprazole daily for 18 weeks. Control endoscopies were performed at 6 and 18 weeks after beginning treatment.Results. Duodenal gastric metaplasia regression was observed in all ( ) patients in whom Helicobacter pylori was eradicated, but in only 3 out of 6 patients in whom eradication was not achieved (p<0.001).Conclusions. The present results suggest that Helicobacter pylori eradication associated with prolonged acid suppression may represent a good therapeutic strategy to achieve duodenal gastric metaplasia regression and highlight the combined role of acid and Helicobacter pylori in the pathogenesis of duodenal gastric metaplasia.     

The Impact of Dyspepsia Definition on Prevalence Estimates: Considerations for Future Researchers

Background: The role of Helicobacter pylori infection in functional dyspepsia is still controversial, and subgroups of patients with functional dyspepsia who may benefit from H. pylori eradication should be identified. Patients with functional dyspepsia and antrum‐predominant H. pylori‐positive chronic gastritis, it has been argued, have fewer symptoms after eradication therapy. In the present study, we analysed the clinical significance of antrum‐predominant gastritis on the long‐term prognosis of functional dyspepsia. Methods: Consecutive unselected dyspeptic patients were investigated in primary care and the patients with functional dyspepsia were enrolled in this long‐term follow‐up study. Altogether 182 patients were recruited: 65 with normal histology of the stomach, 36 with antrum‐predominant gastritis, 21 with corpus‐predominant gastritis and 60 with pangastritis. Patients' medical histories were reviewed after 6 to 7 years, with total number and outcome of repeated investigations analysed. At the end of follow‐up, all patients were invited for voluntary gastroscopy. Results: At the end of follow‐up, the proportion of asymptomatic patients ranged from 21% (normal histology) to 26% (antrum‐predominant gastritis). No statistically significant differences between groups appeared in regard to re‐visits or to proportion of patients examined by sigmoideo‐ or colonoscopy during follow‐up. Patients with antrum‐predominant gastritis less often underwent upper endoscopy. Peptic ulcer was more frequent (P?=?0.05) in patients with antrum gastritis than in other groups, but no other differences existed among any organic gastrointestinal findings. No significant differences between subgroups appeared among the 30% of patients using drugs for upper abdominal complaints during the previous year. Conclusions: Functional dyspepsia has an excellent long‐term prognosis. Antrum‐predominant gastritis in functional dyspepsia seems to carry an increased risk for peptic ulcer, and for this group in particular, H. pylori eradication should be considered. This finding requires confirmation in future studies performed in primary care.     

Relationship between antral lymphocyte density and basal gastrin levels in patients with Helicobacter pylori infection

BACKGROUND: The mechanism by which Helicobacter pylori causes hypergastrinaemia is not completely understood. AIM: To evaluate whether antral lymphocyte density could play a role in this alteration. METHODS: A total of 12 patients with active duodenal ulcer and 10 with non-ulcer dyspepsia were enrolled upon detection of Helicobacter pylori infection at endoscopy Enrolled as controls were 7 matched dyspeptic patients without Helicobacter pylori infection. Biopsy specimens were collected for Helicobacter pylori and histological assessments, and for antral lymphocyte density assessment by a histomorphometric method. A blood sample was obtained from each patient to determine basal gastrin levels. All patients were controlled by a further endoscopy 4 weeks after the end of Helicobacter pylori treatment. RESULTS: Antral lymphocyte density (5,464 +/- 1,328 and 5,635 +/- 1,186 vs 2,267 +/- 557 lymphocytes/mm2; p<0.001 and p<0.001, respectively) and gastrin levels (66.7 +/- 14.1 and 60.4 +/- 21.7 vs 40.7 +/- 7.8 pg/dl; p=0.004 and p=0.02, respectively) were higher in duodenal ulcer and non-ulcer dyspepsia patients than in controls, while no significant differences emerged between duodenal ulcer and non-ulcer dyspepsia patients. There was a significant direct correlation between antral lymphocyte density and gastrin levels both in duodenal ulcer (r=0.77; p=0.003) and in non-ulcer dyspepsia (r=0.75; p=0.03) patients, while no correlation was found in controls [r=0.12; p=0.8). After treatment, this correlation persisted in 10 eradication failure patients (r=0.68; p=0.027), but disappeared in those successfully cured. CONCLUSIONS: These data suggest that lymphocyte density in the antral mucosa could play a role in the impaired gastrin production occurring in patients with Helicobacter pylori infection.     

Evaluation of Helicobacter pylori infection and other risk factors in patients with benign peptic ulcer disease

ObjectiveTo assess and compare the risk factors in patients with benign gastric and duodenal ulcers and to correlate the prevalence of Helicobacter pylori (H. pylori) infection in benign peptic ulcer disease.MethodsA total of 30 consecutive patients with peptic ulcer disease were included in this study after upper gastrointestinal endoscopy. Their clinical profile and endoscopic findings were noted. Antral biopsies were subjected to histopathological examination and urease test for detection of H. pylori. Results were correlated. The study was cleared by the Institute Research Council and the Ethics committee.ResultsThe male: female ratio was 11:4. Overall, H. pylori infection was prevalent in 93.3% of the patients. Patients who took spicy food had a significantly higher rate of H. pylori positivity (P=0.04). Smoking, alcohol intake and NSAIDs did not affect H. pylori status in patients. There was no significant association between the site of the ulcer and H. pylori infection.ConclusionsBased on our observations we conclude that prevalence of H. pylori infection is similar in duodenal and gastric ulcers and intake of spicy food is a significant risk factor.     

Helicobacter pylori seropositivity among the patients with acute dyspepsia

Acute dyspepsia is a common gastrointestinal problem in clinical practice. This disease is due to the poor dietary behavior and there is a scientific evidence that the gastric infection by Helicobacter pylori is the cause of this medical disorder. Here, the authors report on the prevalence of Helicobacter pylori seropositivity among the patients presenting with acute dyspepsia in a primary care center.     

Dyspepsia in General Practice: History and Symptoms in Relation to Helicobacter pylori Serum Antibodies

Hovelius B, Andersson SI, Hagander B, Mölstad S, Reimers P, Sperlich E, Wadström T. Dyspepsia in general practice: history and symptoms in relation to Helicobacter pylori serum antibodies. Scand J Gastroenterol 1994;29:506-510.

Background: This study was designed to explore the relationships between serologic Helicobacter pylori positivity and demographic, behavioural, and symptomatologic factors in patients consulting foi dyspeptic symptoms in general practice.

Methods: H. pylori enzyme-linked immunosorbent assay results and checklist data were collected by general practitioners at three community health centres in southern Sweden from consecutive patients aged 18-65 years with upper abdominal pain or discomfort (dyspepsia).

Results: Of the 130 available patients with dyspepsia, 127 agreed to participate, 45 (mean age, 41.2 years) being classified as H. pylori-positive and 82 (mean age, 33.5 years) as H. pylori-negative. Manual workers were diagnosed as H. pylori-positive significantly more often than were non-manual workers (p < 0.05). Of those patients examined earlier by gastroscopy or roentgenography, H. pylori-positives reported stomach or duodenal ulcer significantly more often than did H. pylori-negatives (p < 0.01). H. pv/on-positives reported stomach/duodenal ulcer in their parents/siblings to a significantly greater extent than did H. pylori-negatives (45.2% versus 10.1%, p< 0.001). H. pylori-negatives reported stress-generated symptoms significantly more often than did H. pylori-positXves (82.9% versus 61.5%, p <0.01). Hierarchical regression analyses showed that, when age and sex were controlled for, the ability of each of these measures to predict the serologic results remained significant.

Conclusions: Higher levels of H. pylori antibodies in dyspeptic patients appear to be associated with a relatively low self-perception of stress, with manual work, with being older, and with the occurrence, both in the patients themselves and in their close relatives, of stomach/duodenal ulcer.     

Cure of Helicobacter pylori-positive active duodenal ulcer patients: double-blind, multicentre, 12-month study comparing a two-week dual vs a one-week triple therapy

Aims. To compare a two-week dual therapy to a one-week triple therapy for the healing of duodenal ulcer and the eradication of the Helicobacter pylori infection.Patients and Methods. A total of 165 patients with active duodenal ulcer were enrolled in the study. At entry, endoscopy, clinical examination and laboratory tests were performed. Histology and the rapid urease test were used to diagnose Helicobacter pylori infection. Patients received either lansoprazole 30 mg plus amoxycillin 1 g bid for two weeks (two-week, dual therapy) or lansoprazole 30 mg plus amoxycillin 1 g plus tinidazole 500 mg bid for one week plus lansoprazole qd for an additional week (one-week, triple therapy). Two and twelve months after cessation of therapy, endoscopy and clinical assessments were repeated.Results. Duodenal ulcer healing and Helicobacter pylori eradication were both significantly greater (p<0. 0001) in the triple therapy group (healing: 98.6%; Helicobacter pylori cure rate: 72.6%) than in the dual therapy group (healing: 77.3%; Helicobacter pylori cure rate: 33.3%). Ulcers healed more frequently in Helicobacter pylori-cured than in Helicobacter pylori-not cured patients (94.9% vs. 77.2%; p<0.0022). After one year, Helicobacter pylori eradication was re-confirmed in 46/58 patients previously treated with the triple therapy and in 10/40 patients treated with the dual therapy (p<0.0001). Only three duodenal ulcer relapses were observed throughout follow-up: all were in Helicobacter pylori-not cured patients.Conclusions. Triple therapy was more effective than dual both in curing Helicobacter pylori infection and healing active duodenal ulcers. The speed of ulcer healing obtained after only 7 days of antibiotics and 14 days of proton pump inhibitors confirmed that longer periods of anti ulcer therapy were not necessary. Helicobacter pylori -not cured patients had more slowly healing ulcers which were more apt to relapse when left untreated.     

Impact of <Emphasis Type="Italic">Helicobacter pylori</Emphasis> Infection and Microscopic Duodenal Histopathological Changes on Clinical Symptoms of Patients with Functional Dyspepsia

Aim  

To evaluate the microscopic histopathological changes in duodenal tissue and its relationship to the severity of symptoms in patients with functional dyspepsia while taking the effect of Helicobacter pylori (H. pylori) infection into account.     

Hypersecretory duodenal ulcer and Helicobacter pylori infection: for-year follow-up study

Background. About 10% of duodenal ulcer patients are characterized by gastric acid hypersecretion with normal gastrin values. Relapsing duodenal ulcer after Helicobacter pylori cure has been related to high acid output and maintenance antisecretory therapy has been suggested in hypersecretory duodenal ulcer patients. The role of Helicobacter pylori infection and the effects of Helicobacter pylori cure in hypersecretory duodenal ulcer patients still remain to be fully studied.Aim. To study: a) whether gastric acid hypersecretion “per se” is a risk factor for duodenal ulcer recurrence; b) whether maintenance antisecretory therapy is necessary after eradication in hypersecretory duodenal ulcer patients.Patients. The study population comprised 8 hypersecretory duodenal ulcer patients, selected from a population of 79 Helicobacter pylori-positive duodenal ulcer patients.Methods. Hypersecretory duodenal ulcer patients were followed-up for at least 4 years after eradication. Gastric acid secretion was measured again 12 months after Helicobacter pylori eradication. Gastroscopy with histology was performed 3, 6, 12 and 36 months after treatment, ¹³C-urea breath test after 42 months; clinical questionnaires were completed every 6 months.Results. After eradication, despite a not significantly reduced high acid output (median value of basal acid output and pentagastrin-stimulated acid output, respectively, 23.1 mEg/h and 64. 1 mEg/h before treatment vs 16 mEg/h and 49.7 mEq/h 12 months after treatment), all patients were free from symptoms, none of them had duodenal ulcer relapse or complications (7/8 before treatment), or needed antisecretory maintenance therapy, except for one patient taking non-steroidal anti-inflammatory drugs.Conclusions. These findings, obtained in a selected population of hypersecretory duodenal ulcer patients with long-term follow-up, suggest that after successful Helicobacter pylori eradication gastric acid hypersecretion “per se” is not able to determine the recurrence of duodenal ulcer.     

Life Events and Stress in Patients with Functional Dyspepsia Compared with Patients with Duodenal Ulcer and Healthy Controls

Background: Life events and stress may be important for functional dyspepsia and duodenal ulcer. Methods: The perception of life events in the preceding 6 months was recorded in 100 patients with functional dyspepsia, 100 patients with duodenal ulcer, and 100 healthy controls. In addition, psychologic and social factors were assessed. Results: Patients with functional dyspepsia experienced significantly more life events than patients with duodenal ulcer and healthy controls. The difference in life events between the groups was due to the difference in stressful life events. The patients with functional dyspepsia had higher levels of state-trait anxiety, general psychopathology, and depression than patients with duodenal ulcer and healthy controls. Conclusion: Patients with functional dyspepsia had higher scores on negative life events than patients with duodenal ulcer and healthy controls. This may be causally related to the higher levels of anxiety, depression, and general psychopathology in these patients.