Low point prevalence of peptic ulcer in normal individuals with Helicobacter pylori infection

Objective: A recent study from Italy reported a high prevalence of ulcer disease in asymptomatic Helicobacter pylori infection. Such results are at variance with previous endoscopy screening studies. Our study was performed to obtain data on ulcer prevalence in normal H. pylori-infected subjects in the United States. Methods: One hundred and ninety healthy individuals of either gender, over the age of 18, were studied. After completion of a detailed questionnaire and a urea breath test for H. pylori status, endoscopy was performed. Ulcer was defined as a mucosal ulceration >5 mm in diameter and with apparent depth. Results: There were 108 (57%) women and 82 (43%) men. The mean (± SD) age was 38.9 (± 10.7) yr, range 21-79 yr. Careful history obtained after enrollment revealed presence of dyspeptic symptoms in 35 subjects (18%); the remaining 155 individuals were completely symptom- free. Infection with H. pylori was present in 102 subjects (54%). The infection rate was highest in Hispanics (70%), followed by African-Americans (58%), Caucasians (38%), and Asians (17%). The prevalence increased with age. Only two (1%) of 190 subjects, both with H. pylori infection, had peptic ulcer. In the H. pylori-infected group, the prevalence of peptic ulcer was 2%. Conclusion: In the United States, significant unrecognized and asymptomatic gastroduodenal disease is uncommon in H. pylori-infected individuals. These findings do not support the need for a mass screening program for H. pylori infection or for the use of antimicrobial treatment of asymptomatic subjects with this infection.