Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지

Changes of Helicobacter pylori-Positive Peptic Ulcer Disease:Based on Data from a General Hospital

Helicobacter pylori 양성 소화성 궤양의 변동추이

Jung, Hye-Kyung;Na, Yoon-Ju;Moon, Il-Hwan
정혜경;나윤주;문일환

  • Published : 20060000
⟨ Previous Next ⟩

Abstract

The incidence of Helicobacter pylori(H. pylori)-positive ulcer appears to be decreasing recently in the Western countries, and this has been influenced by the epidemiologic changes of H. pylori infection. Therefore, we aimed to determine the trends for the frequency of H. pylori-positive peptic ulcer disease (PUD) during recent 7 years in Korea. Methods: All 1,723 patients who had an endoscopic diagnosis of PUD from 1997 to 2003 were included in this study. H. pylori was considered present if the CLO test and/or the histology and the urea breath test were positive for H. pylori. Results: H. pylori-positive ulcers were seen in 1,354/1,723 patients (78.6%). The positive rate of H. pylori infection in patients with PUD was 85.9% in 1997, 79.2% in 1999, 76.2% in 2001 and 73.1% in 2003, and this showed a decreasing annual trend (p＜0.001). H. pylori-positive PUD was more prevalent in duodenal ulcer than in gastric ulcer, and in the patients who were aged person and male. During the recent 7 years, H. pylori- positive PUD has decreased in patients with duodenal ulcer, and especially for patients younger than 60 years and in the male group. Conclusions: The frequency of H. pylori-positive PUD is possibly decreasing in the recent 7 years. Prospective, multicenter trial studies are necessary to confirm this trend and find out the cause.

Helicobacter pylori (H. pylori) 감염은 소화성 궤양의 중요한 원인이나 최근 구미에서 소화성 궤양환자 중 H. pylori 감염 양성률이 감소한다는 보고가 있고, 국내에서도 H. pylori 감염 유병률이 감소하고 있는 것으로 추정되며, 이는 H. pylori 감염과 연관된 질환의 빈도와 임상양상에 영향을 줄 수 있다. 저자등은 최근 7년간 소화성 궤양 환자에서 H. pylori 감염 양성률과 임상 양상의 변화를 알아보고자 본 연구를 시행하였다. 대상 및 방법: 1997년 1월부터 2003년 6월까지 위내시경 검사를 시행하여 소화성 궤양으로 진단 받은 환자 1,723예를 연구대상으로 하였다. H. pylori 감염 양성은 신속요소분해효소 검사, 조직학적 검사, 요소호기 검사 중 1가지라도 양성인 경우로 정의하였다. 결과: 전체 대상 환자 1,723명 중 H. pylori 양성궤양은 1,354명(78.6%)이었다. 소화성 궤양 환자 중 H. pylori 양성률은 위궤양보다 십이지장 궤양에서, 여성에 비해 남성에서, 60세 초과 환자군보다 60세 이하 환자군에서 높았다. 연도별 H. pylori 양성 소화성 궤양의 발생 빈도는 1997년 85.9%, 1999년 79.2%, 2001년 76.2%, 2003년 73.1%로 통계적으로 유의하게 감소하는 추세를 보였다(p＜0.01). 이를 위궤양 환자군과 십이지장 환자군에서 성별과 연령으로 보정한 후 추이분석을 실시한 결과, 십이지장 환자군 중 60세 이하 환자군과 남성에서 관찰기간 동안 유의하게 H. pylori 양성률이 감소하였다. 결론: 최근 소화성 궤양 환자 중 H. pylori 양성률은 연도별로 감소하는 추세이며, 이는 십이지장 궤양 환자 중 남자 및 60세 이하 환자군에서 뚜렷하게 관찰되었다. 향후 이러한 추이변동의 원인을 분석하고 이를 확인하기 위한 전향적, 다기관 연구가 필요하리라 생각한다

Keywords

References

  1. Marshall BJ, McGechie DB, Rogers PA, Glancy RJ. Pyloric Campylobacter infection and gastroduodenal disease. Med J Aust 1985;142:439-444
  2. Marshall BJ. Helicobacter pylori. Am J Gastroenterol 1994; 89:116S-128S
  3. Bak YT, Kim JH, Kim JG, et al. 14C-urea breath test: a noninvasive and rapid test for the gastric Campylobacter pylori infection. Korean J Med 1988;34:47-56
  4. Sung JW, Yook EJ, Im EH, et al. Prevalence of Helicobacter pylori infection in peptic ulcer and gastric cancer. Korean J Med 1993;45:77-83
  5. Jang MK, Kim HY, Cho BD, et al. Prospective study for the prevalence of Helicobacter infection in patients with gastric ulcer and duodenal ulcer among Korean population. Korean J Med 1997;52:457-464
  6. Kwag IS, Song GS, Jang TJ, Jung MK. Prevalence of Helicobacter pylori in upper gastrointestinal diseases. J Korean Acad Fam Med 1997;18:22-28
  7. Kim NY, Park YJ, Ahn KJ, et al. The role of Helicobacter pylori and NSAID in patients with benign gastric ulcer. Korean J Med 1998;54:502-513
  8. Lee HS, Kim SK, Cho HC, et al. Detection rates of Helicobacter pylori among gastric diseases. Korean J Curr Med 1999;42:34-38
  9. Cho JJ. Prevalence of Helicobacter pylori infection in patients of peptic ulcer among Korean people. J Korean Acad Fam Med 1999;20:1084-1090
  10. Quan C, Talley NJ. Management of peptic ulcer disease not related to Helicobacter pylori or NSAIDs. Am J Gastroenterol 2002;97:2950-2961 https://doi.org/10.1111/j.1572-0241.2002.05390.x
  11. Xia HH, Phung N, Kalantar JS, Talley NJ. Demographic and endoscopic characteristics of patients with Helicobacter pylori positive and negative peptic ulcer disease. Med J Aust 2000; 173:515-519
  12. Meucci G, Di Battista R, Abbiati C, et al. Prevalence and risk factors of Helicobacter pylori-negative peptic ulcer: a multicenter study. J Clin Gastroenterol 2000;31:42-47 https://doi.org/10.1097/00004836-200007000-00010
  13. Ciociola AA, McSorley DJ, Turner K, Sykes D, Palmer JB. Helicobacter pylori infection rates in duodenal ulcer patients in the United States may be lower than previously estimated. Am J Gastroenterol 1999;94:1834-1840 https://doi.org/10.1111/j.1572-0241.1999.01214.x
  14. Laine L, Hopkins RJ, Girardi LS. Has the impact of Helicobacter pylori therapy on ulcer recurrence in the United States been overstated? A meta-analysis of rigorously designed trials. Am J Gastroenterol 1998;93:1409-1415
  15. Yoon JG, Kim JK, Lee DH, et al. Clinical study for peptic ulcer. Korean J Gastroenterol 2000;36:336-347
  16. Kim SH, Kang HW, Yoon WJ, et al. Clinical characteristics of peptic ulcer in the aged in Korea. Korean J Med 2004;66: 19-25
  17. Bytzer P, Teglbjaerg PS. Helicobacter pylori-negative duodenal ulcers: prevalence, clinical characteristics, and prognosis-results from a randomized trial with 2-year follow-up. Am J Gastroenterol 2001;96:1409-1416
  18. Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 1996;20:1161-1181 https://doi.org/10.1097/00000478-199601000-00001
  19. Ohara S, Kato M, Asaka M, Toyota T. Studies of 13C-urea breath test for diagnosis of Helicobacter pylori infection in Japan. J Gastroenterol 1998;33:6-13 https://doi.org/10.1007/PL00009968
  20. Cutler AF, Havstad S, Ma CK, Blaser MJ, Perez-Perez GI, Schubert TT. Accuracy of invasive and noninvasive tests to diagnose Helicobacter pylori infection. Gastroenterology 1995; 109:136-141 https://doi.org/10.1016/0016-5085(95)90262-7
  21. Jyotheeswaran S, Shah AN, Jin HO, Potter GD, Ona FV, Chey WY. Prevalence of Helicobacter pylori in peptic ulcer patients in greater Rochester, NY: is empirical triple therapy justified? Am J Gastroenterol 1998;93:574-578 https://doi.org/10.1111/j.1572-0241.1998.167_b.x
  22. Tovey FI, Hobsley M, Kaushik SP, et al. Duodenal gastric metaplasia and Helicobacter pylori infection in high and low duodenal ulcer-prevalent areas in India. J Gastroenterol Hepatol 2004;19:497-505 https://doi.org/10.1111/j.1440-1746.2003.03320.x
  23. Higuchi K, Arakawa T, Fujiwara Y, et al. Is Helicobacter pylori-negative duodenal ulcer masked by the high prevalence of H. pylori infection in the general population? Am J Gastroenterol 1999;94:3083-3084
  24. Sugiyama T, Nishikawa K, Komatsu Y, et al. Attributable risk of H. pylori in peptic ulcer disease: does declining prevalence of infection in general population explain increasing frequency of non-H. pylori ulcers- Dig Dis Sci 2001;46:307-310 https://doi.org/10.1023/A:1005628121546
  25. Kim JH, Kim HY, Kim NY, et al. Seroprevalence of Helicobacter pylori infection in asymptomatic people in Korea. Korean J Med 2000;59:389-397
  26. Lim DS, Cho KC, Kim HC. Seroepidemiological study of anti-HAV in CheonBuk Province in 1989. Korean J Med 1992;43:57-65
  27. Korea national statistical office. Population projections (yearly 1960-2050). Statistical database (KOSIS). (http://kosis.nso.go.kr)
  28. Kim JK, Jung IS, Ahn BM, et al. An epidemioloical and endoscopic study of peptic ulcer in 1179 cases. Korean J Med 1990;39:165-173
  29. Hawkey CJ, Langman MJ. Non-steroidal anti-inflammatory drugs: overall risks and management. Complementary roles for COX-2 inhibitors and proton pump inhibitors. Gut 2003;52: 600-608 https://doi.org/10.1136/gut.52.4.600