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January 9, 1995

Nonulcer Dyspepsia in a Dutch Working Population and Helicobacter pylori: Ulcer History as an Explanation of an Apparent Association

Arch Intern Med. 1995;155(1):82-87. doi:10.1001/archinte.1995.00430010090012

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)