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Ulcer History as an Explanation of an Apparent Association

Ronald J. Schlemper, MD; Sjoerd D. J. van der Werf, PhD; Jan P. Vandenbroucke, PhD; Izäk Biemond, PhD; Cornelis B. H. W. Lamers, PhD

Arch Intern Med. 1995;155(1):82-87.

Abstract
Background
There is considerable debate about whether Helicobacter pylori infection is important in causing non-ulcer dyspepsia. Many studies assessing this relationship have been performed in selected patient populations and included patients with a history of peptic ulcer. General population-based data with attention to ulcer history are needed to clarify this relationship.

Methods
A questionnaire on ulcer history and dyspeptic symptoms during the preceding 3-month period was obtained from apparently healthy employees who underwent a periodic medical examination in the Netherlands. In addition, serum samples were analyzed for anti—H pylori IgG antibodies.

Results
A total of 427 men and 73 women, aged 22 to 69 years, participated in the study. None of the women but 27 men (6%) had a previous diagnosis of peptic ulcer. Among 19 unoperated-on men with verified duodenal (17 subjects) and gastric (two subjects) ulcer, 89% were H pylori positive, while 74% had frequent dyspeptic symptoms in the 3 months before the study. Among the 400 men and 73 women without an ulcer history, the 3-month period prevalence of frequent dyspepsia was 13% and 21%, respectively. The rate of H pylori positivity was 25% in subjects with nonulcer dyspepsia and 29% in all others. The H pylori infection rate increased with age and with a lower occupational level but was independent of gender. In the male population, various differences in symptoms between H pylori—positive and H pylori—negative subjects could be detected when the 27 subjects with a history of ulcer were included, whereas these differences disappeared when these subjects were excluded.

Conclusions
In the Dutch working population, nonulcer dyspepsia is not related to H pylori infection, whereas for duodenal ulcer the relationship is clear. The apparent association between dyspeptic symptoms and H pylori infection is entirely accounted for by subjects with an ulcer history.

(Arch Intern Med. 1995;155:82-87)

Author Affiliations
From the Departments of Internal Medicine (Dr Schlemper), Clinical Epidemiology (Dr Vandenbroucke), and Gastroenterology (Drs Biemond and Lamers), University Hospital, Leiden, the Netherlands, and the Department of Internal Medicine, Westeinde Hospital, the Hague, the Netherlands (Dr van der Werf).

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