Clinical features and natural history of idiopathic peptic ulcers: a retrospective case–control study

<b>Objectives:</b> Peptic ulcer disease (PUD) is still common worldwide and is characterized by high mortality and morbidity. Following the decline of <i>Helicobacter pylori</i> infection, the detection of idiopathic PUD (IPUD) has become more frequent, making diagnosis and treatment more difficult. In this study, the clinical features and natural history of IPUD were analyzed. <b>Methods:</b> This was a retrospective case‒control study conducted in a tertiary care setting (University of Sassari, Italy). Records of 9,212 patients undergoing upper endoscopy from 2002 to 2018 were analyzed. Following the exclusion of <i>H. pylori</i>, NSAIDs, and unusual PUD causes, the remaining were labelled as IPUD. Cases (IPUD) and controls (PUD negative) were compared, adjusting for several covariates through multivariate logistic regression models. <b>Results:</b> Among 380 PUD, 95 were considered IPUD. The proportion rose over the study period in contrast to the decline of <i>H. pylori</i>-PUD. Factors significantly associated with IPUD, after adjusting for all covariates, were age (OR, 3.520; 95% CI, 1.634 − 7.585), male sex (OR, 3.126; 95% CI, 1.888 − 5.176), hospitalization (OR, 2.968; 95% CI, 1.926 − 4.575), and number of medications (OR, 2.808; 95% CI, 1.178 − 6.735). A clinical history positive for PUD was the major risk associated with IPUD (OR, 3.729; 95% CI, 2.050 − 6.785). Patients with IPUD were treated with the highest proton pump inhibitor (PPI) dose for 40–60 days. Follow up endoscopy showed a cure rate of 97.6%. <b>Conclusion:</b> The relative proportion of IPUD is increasing in our population in contrast to the drop of <i>H. pylori</i>-PUD. Treatment with high-dose PPI, and for a long duration, heals IPUD and protects from recurrence.

**研究目标：** 消化性溃疡病（Peptic ulcer disease, PUD）仍是全球范围内的常见疾病，以高病死率与高发病率为主要特征。随着幽门螺杆菌（Helicobacter pylori）感染率的下降，特发性消化性溃疡病（idiopathic PUD, IPUD）的检出愈发频繁，使得该病的诊疗难度进一步加大。本研究针对特发性消化性溃疡病的临床特征与自然病程展开分析。**研究方法：** 本研究为一项在三级医疗中心（意大利萨萨里大学）开展的回顾性病例对照研究。研究人员对2002年至2018年间共计9212例行上消化道内镜检查患者的病历资料进行了回顾分析。在排除幽门螺杆菌感染、非甾体类抗炎药（Non-Steroidal Anti-Inflammatory Drugs, NSAIDs）暴露及其他特殊病因导致的消化性溃疡后，剩余病例被归类为特发性消化性溃疡病。将特发性消化性溃疡病患者作为病例组，内镜检查阴性的非溃疡患者作为对照组，通过多因素logistic回归模型校正多项协变量后，对两组患者的临床特征进行比较。**研究结果：** 本研究共纳入380例消化性溃疡病患者，其中95例被确诊为特发性消化性溃疡病。随着研究周期的推进，特发性消化性溃疡病的占比呈上升趋势，而幽门螺杆菌相关性消化性溃疡病的占比则逐渐下降。校正所有协变量后，与特发性消化性溃疡病显著相关的独立危险因素包括：年龄（比值比（odds ratio, OR）=3.520，95%置信区间（confidence interval, CI）：1.634~7.585）、男性性别（OR=3.126，95%CI：1.888~5.176）、住院史（OR=2.968，95%CI：1.926~4.575）以及用药种数（OR=2.808，95%CI：1.178~6.735）。既往存在消化性溃疡病史是特发性消化性溃疡病最强的独立危险因素（OR=3.729，95%CI：2.050~6.785）。特发性消化性溃疡病患者接受了最高剂量的质子泵抑制剂（Proton Pump Inhibitor, PPI）治疗，疗程为40~60天。随访内镜检查结果显示，溃疡治愈率达97.6%。**研究结论：** 相较于幽门螺杆菌相关性消化性溃疡病占比的下降，本研究人群中特发性消化性溃疡病的相对占比正逐步升高。采用高剂量、长疗程的质子泵抑制剂治疗方案，可有效治愈特发性消化性溃疡病，并降低疾病复发风险。