Based on a large trial of Helicobacter pylori-positive peptic ulcer patients, Dr Perttu E. T. Arkkila and colleagues from Finland studied whether the size of the ulcer, along with other clinical and histological characteristics, has any effect on healing.
They also studied the clinical and endoscopic characteristics associated with size of the peptic ulcer.
A total of 333 consecutive patients with H. pylori infection and peptic ulcer were enrolled (mean age 54.8±12.7 years).
|Patients older than 50 and smokers had larger ulcers.|
|Scandinavian Journal of Gastroenterology |
Location of the ulcer was recorded by gastroscopy and the presence of H. pylori was assured by a rapid urease test, histology and by serum H. pylori IgG and IgA antibody measurement.
The diameter of the ulcer was measured by placing the opened biopsy forceps (7 mm) beside it.
Biopsy specimens were examined in accordance with the Sydney system.
The mean size of the peptic ulcer was 13.2±8.3 in corpus, 11.3±5.3 in antrum, 13.8±7.8 in angulus, 9.5±5.3 in prepylorus and 9.2±4.7 mm in duodenum (duodenal versus gastric type; p<0.05).
The average size of the ulcers was 9.4±5.3 mm in patients with Forrest III type and 11.5±6.8 in other types (p<0.05).
Patients who were over 50 years of age, currently smoking, or who had corpus-predominant chronic gastritis or atrophic gastritis, had larger ulcers than others.
Size of index ulcers, successful eradication of H. pylori and the presence of atrophic gastritis were independent factors for healing.
The odds ratio was 11.5 (95% CI 3.3-40.5; p<0.01) for eradication of H. pylori, 3.5 (95% CI 1.1-11.2; p<0.05) for size of the index ulcer (<10 mm versus >10 mm) and 3.4 (95% CI 1.2-9.8; p<0.05) for atrophic gastritis versus no atrophy.
Dr Arkkila concluded that, "A number of clinical and endoscopic variables (age, current smoking, corpus-predominant gastritis, Forrest classification) were associated with size of the peptic ulcer in H. pylori-positive patients".