Review article: <i>Helicobacter pylori</i>‐negative duodenal ulcer disease

<jats:sec><jats:label /><jats:p> <jats:italic>Aliment Pharmacol Ther</jats:italic> <jats:bold>30</jats:bold>, 791–815</jats:p></jats:sec><jats:sec><jats:title>Summary</jats:title><jats:p><jats:bold>Background </jats:bold> <jats:italic>Helicobacter pylori</jats:italic> infection rates in duodenal ulcer (DU) patients may be lower than previously estimated.</jats:p><jats:p><jats:bold>Aim </jats:bold> To review the real prevalence of <jats:italic>H. pylori</jats:italic>‐negative DUs and its possible causes.</jats:p><jats:p><jats:bold>Methods </jats:bold> Bibliographical searches in MEDLINE looking for the terms ‘<jats:italic>H. pylori</jats:italic>’ and ‘duodenal ulcer’.</jats:p><jats:p><jats:bold>Results </jats:bold> Mean prevalence of <jats:italic>H. pylori</jats:italic> infection in DU disease, calculated from studies published during the last 10 years including a total of 16 080 patients, was 81%, and this figure was lower (77%) when only the last 5 years were considered. Associations with <jats:italic>H. pylori</jats:italic>‐negative DU were: (1) False negative results of diagnostic methods, (2) NSAID use (21% in studies with <90% infection rate), (3) Complicated DU (bleeding, obstruction, perforation), (4) Smoking, (5) Isolated <jats:italic>H. pylori</jats:italic> duodenal colonization, (6) Older age, (7) Gastric hypersecretion, (8) Diseases of the duodenal mucosa, (9) <jats:italic>Helicobacter</jats:italic>‘<jats:italic>heilmanii</jats:italic>’ infection and (10) Concomitant diseases.</jats:p><jats:p><jats:bold>Conclusion </jats:bold> In patients with <jats:italic>H. pylori</jats:italic>‐negative DU disease, one should carefully confirm that the assessment of <jats:italic>H. pylori</jats:italic> status is reliable. In truly <jats:italic>H. pylori</jats:italic>‐negative patients, the most common single cause of DU is, by far, the use of NSAIDs. Ulcers not associated with <jats:italic>H. pylori</jats:italic>, NSAIDs or other obvious causes should, for the present, be viewed as ‘idiopathic’. True idiopathic DU disease only exceptionally exists.</jats:p></jats:sec>