Non-Helicobacter pylori, Non-NSAIDs 소화성궤양
Non-Helicobacter pylori, Non-NSAID Peptic Ulcer Disease
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Non-Helicobacter pylori, non-NSAID peptic ulcer disease, termed idiopathic peptic ulcer disease (IPUD), is being increasinglyrecognized. Current data suggest that the relative proportion of patients with IPUD among those with peptic ulcers has beenincreasing for the past decade in both the West and East, while the prevalence of H. pylori ulcers has decreased. Potential causativeor risk factors of IPUD include cigarette smoking, genetic predisposition, psychological factors, infections other than H. pylori,non-NSAID drugs or toxins, systemic inflammatory disease, and local mucosal defects. Diagnosis is made after confident exclusionof H. pylori infection by at least two different standard tests and accurate exclusion of unrecognized or surreptitious NSAID use bycareful history taking and serologic assay. IPUD is characterized by higher complication and recurrence rates than other forms ofpeptic ulcer disease and has become a main cause of refractory ulcer disease. Maintenance therapy using proton pump inhibitorsmay be required at higher doses and for longer durations than in H. pylori- or NSAID-associated peptic ulcer diseases. Welldesignednationwide epidemiologic studies are required to fully elucidate this emerging condition.
Abstract
Non-Helicobacter pylori, non-NSAID peptic ulcer disease, termed idiopathic peptic ulcer disease (IPUD), is being increasinglyrecognized. Current data suggest that the relative proportion of patients with IPUD among those with peptic ulcers has beenincreasing for the past decade in both the West and East, while the prevalence of H. pylori ulcers has decreased. Potential causativeor risk factors of IPUD include cigarette smoking, genetic predisposition, psychological factors, infections other than H. pylori,non-NSAID drugs or toxins, systemic inflammatory disease, and local mucosal defects. Diagnosis is made after confident exclusionof H. pylori infection by at least two different standard tests and accurate exclusion of unrecognized or surreptitious NSAID use bycareful history taking and serologic assay. IPUD is characterized by higher complication and recurrence rates than other forms ofpeptic ulcer disease and has become a main cause of refractory ulcer disease. Maintenance therapy using proton pump inhibitorsmay be required at higher doses and for longer durations than in H. pylori- or NSAID-associated peptic ulcer diseases. Welldesignednationwide epidemiologic studies are required to fully elucidate this emerging condition.
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