Monés Xiol J
Gastroenterology Unit, Santa Creu i Sant Pau Hospital, Universidad Autónoma, Barcelona, Spain.
Rev Esp Enferm Dig. 2002 Nov;94(11):687-96.
Although the vast majority of peptic ulcers are widely considered as related to the germ Helicobacter pylori, ulcers exhibiting absence of this infection are increasingly seen in recent years. This fact has been partly related to a decreased prevalence of Helicobacter pylori among the population, a consequence of improved hygiene and housing conditions. Causes in relation to Helicobacter pylori-negative ulcers are: 1. Falsely negative infection diagnostic tests. They represent 25% of ulcers considered as Helicobacter pylori-negative in health-care practice (falsely negative diagnostic test 5%, previous or concomitant therapy with antibiotics, bismuth or proton pump inhibitors 20%). 2. Aspirin (ASA) or non-steroidal anti-inflammatory drug (NSAID) therapy. This is no doubt the most common cause, representing 50 to 60% of all infection-free ulcers. 3. Other causes (Zollinger-Ellison syndrome, Helicobacter heilmannii, generalised gut disease such as Crohn's disease, amyloidosis, eosinophilic gastroenteritis, etc.) may be responsible for less than 5% of all Helicobacter pylori-negative ulcers. 4. "Idiopathic" peptic ulcers. Thus are considered ulcers for which no potential cause may be found, representing 5-15% of all infection-free ulcers. Acid hyper-secretion is probably an important factor in them.
尽管绝大多数消化性溃疡被广泛认为与幽门螺杆菌感染有关，但近年来无该感染的溃疡越来越常见。这一现象部分归因于人群中幽门螺杆菌感染率的下降，这是卫生和居住条件改善的结果。幽门螺杆菌阴性溃疡的病因如下：1. 感染诊断试验假阴性。在医疗实践中，这类假阴性占被认为幽门螺杆菌阴性溃疡的25%（诊断试验假阴性占5%，既往或同时使用抗生素、铋剂或质子泵抑制剂占20%）。2. 阿司匹林（ASA）或非甾体抗炎药（NSAID）治疗。这无疑是最常见的病因，占所有无感染溃疡的50%至60%。3. 其他病因（卓-艾综合征、海氏螺杆菌、全身性肠道疾病如克罗恩病、淀粉样变性、嗜酸性胃肠炎等）在所有幽门螺杆菌阴性溃疡中所占比例不到5%。4. “特发性”消化性溃疡。这类溃疡被认为找不到潜在病因，占所有无感染溃疡的5%至15%。胃酸分泌过多可能是其重要因素。
