High Recurrence Rate of Idiopathic Peptic Ulcers in Long-Term Follow-up

Background/Aims: Our aim was to compare the long-term clinical outcomes of idiopathic peptic ulcer disease (IPUD) with those of Helicobacter pylori-positive and nonsteroidal anti-inflammatory drug (NSAID)-induced peptic ulcer disease (PUD). Methods: Patients with endoscopically diagnosed PUD were retrospectively reviewed. According to their H. py-lori-infection status and history of NSAIDs use, patients were categorized into three groups: H. pylori-positive PUD, NSAID-induced PUD, and IPUD. Clinical outcomes were analyzed, and the recurrence rate of PUD was compared among the three groups. Results: A total of 238 patients were enrolled. Those with IPUD, NSAID-induced PUD, and H. pylori-positive PUD comprised of 56, 60, and 122 patients, respectively. The 5-year cumulative incidences of recurrent ulcers were 24.3 % (95 % confidence interval [CI], 11.6 % to 37.0%) in IPUD, 10.9 % (95 % CI, 2.6 % to 19.2%) in NSAID-induced PUD, and 3.8 % (95 % CI, 0.1 % to 7.5%) in H. pylori-positive PUD (IPUD vs NSAID-induced PUD/H. pylori-positive PUD, p=0.43/ p<0.001 by log-rank test). In the Cox-proportional hazards model, only IPUD remained as an independent risk factor associated with recurrent ulcers (hazard ratio, 5.97; 95% CI, 1.94 to 18.34; p=0.002). Conclusions: IPUD exhibited a higher recurrence rate than H. pylori-positive and NSAID-induced PUD in long-term follow-up and was an independent risk factor for ulcer recurrence. (Gut Liver 2013;7:175-181) Key Words: Helicobacter pylori; Idiopathic peptic ulcer; Non-steroidal anti-inflammatory drug; Recurrenc