Young Onset Peptic Ulcer Disease and Non-Ulcer Dyspepsia Are Separate Entities

Abstract

The characteristics of peptic ulcer and non-ulcer dyspepsia in young men were studied in 202 consecutive conscripts who attended Central Military Hospital in Helsinki because of long-standing upper abdominal complaints. Active peptic ulceration (APU) was found in 48 patients, inactive peptic ulcer disease (IPU) was diagnosed in 77 patients, non-ulcer dyspepsia (NUD) was diagnosed in 52 patients. In 25 cases the reason for symptoms was another disease, and these patients were excluded from the study. A control series (CON) consisted of 30 symptomless healthy young male volunteers. The likelihood of discriminating between peptic ulcer disease and non-ulcer dyspepsia in a young male patient with dyspepsia are indicated by odds ratios (OR) and its 95% confidence limits (CL 95). Active peptic ulcer disease differs from NUD, e.g., by 1) presence of antrum gastritis, OR 41.5 (CL 95: 10.1–171), 2) Helicobacter pylori in the gastric mucosa, OR 31.0 (7.4–130), 3) Lewis^a+ phenotype, OR 8.9 (1.7–45.4), 4) serum pepsinogen I (S-PGI) >100 μg/l, OR 4.6 (1.7–12.4), 5) non-secretor status, OR 4.3 (1.6–11.6), and 6) O-blood group, OR 3.0 (1.2–7.7). In conclusion, the status of gastroduodenal mucosa, gastric secretion pattern and distribution of some genetic markers in patient series indicate that young onset peptic uicer and non-ulcer dyspepsia are two separate entities. Helicobacter-positive antrum gastritis is the best determinant of ulcer risk, but also high S-PGI, Lewis^a+ phenotype, non-secretor status and O-blood group are signs of increased risk of peptic ulcer.

Key Words:

• Peptic ulcer
• non-ulcer dyspepsia
• gastritis
• Helicobacter pylori
• gastric secretion
• pepsinogens
• gastrin
• ABO-blood groups
• Lewis^a+ phenotype
• secretor status