Q J Med 2002; 95: 749-752
© 2002 Association of Physicians
Possible absence of Helicobacter pylori in the early stages of duodenal ulceration
From the Departments of Surgery and 1 Medical Microbiology, Royal Free and University College Medical School, London, UK
Received 3 October 2001 Accepted for publication 6 June 2002.
Background: Helicobacter pylori is thought to be a cause of duodenal ulceration, but there is some evidence that it is found less often in early than in later disease.
Aim: To assess the presence of H. pylori in patients undergoing endoscopy for dyspepsia, with respect to their duration of symptoms.
Design: Retrospective case note review.
Methods: Patients were categorized as having a history greater or less than 6 months, and as H. pylori-positive or -negative, using biopsy rapid urease, culture and PCR tests.
Results: Thirty-two duodenal ulcer patients with a history >6 months were all H. pylori-positive according to the PCR test; the five with a shorter history were H. pylori-negative. No patient H. pylori-negative by PCR was positive by the other tests.
Discussion: H. pylori was (at least) less commonly present before 6 months. It is possible that H. pylori, although nearly always present after 6 months, is not present at the onset of the disease. Confirmation of this finding would imply that infection with the organism is not the cause of duodenal ulceration, but a factor producing recurrence and chronicity.
Address correspondence to Professor M. Hobsley, Fieldside, Barnet Lane, London N20 8AS. e-mail: m.hobsley{at}ucl.ac.uk
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