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.