What Is the Role of Helicobacter pylori in Peptic Ulcer and Gastric Cancer Outside the Big Cities?

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Abstract
Helicobacter pylori is apparently the etiologic agent of 90% of duodenal ulcers (DUs), 80% of gastric ulcers (GUs) not induced by nonsteroidal anti-inflammatory drugs, and gastric carcinoma (GC). Our community-based investigations and retrospective reviews, however, have been unable to substantiate these associations. A retrospective review of 30 patients with GC revealed only 2 (6.6%) patients with H. pylori infection. A retrospective review of all patients with the diagnosis of DU (332) was undertaken. One hundred sixty-six had gastroscopy-confirmed DUs, and 112 had three antral biopsies. Only 36 (32%) of 112 were H. pylori-positive. Of bleeding ulcers, 25% were H. pylori-positive. These findings differ from the literature, and it provoked us to study prospectively all patients undergoing endoscopy. Biopsy specimens were obtained from the cardia and antrum and were stained for H. pylori. Of 272 patients' biopsy specimens, 65 (24%) of 272 wereH. pylori-positive. Sixteen DUs were diagnosed, and five (31%) were H. pylori-positive. There were 36 GUs, and 11 (30%) were H. pylori-positive. The prevalence of H. pylori in consecutive patients undergoing endoscopy is 24% in Orlando, Florida. This is not significantly different from the prevalence of H. pylori in patients with DUs and GUs. Further community-based studies are needed to determine the widespread applicability of these data in the United States.