Possible absence of Helicobacter pylori in the early stages of duodenal ulceration.

Background :  Helicobacter pylori is thought to be a cause of duodenal ulceration, but there is some evidence that it is found less often in early than in later disease. Aim : To assess the presence of H. pylori in patients undergoing endoscopy for dyspepsia, with respect to their duration of symptoms. Design : Retrospective case note review. Methods : Patients were categorized as having a history greater or less than 6 months, and as H. pylori ‐positive or ‐negative, using biopsy rapid urease, culture and PCR tests. Results : Thirty‐two duodenal ulcer patients with a history >6 months were all H. pylori ‐positive according to the PCR test; the five with a shorter history were H. pylori ‐negative. No patient H. pylori ‐negative by PCR was positive by the other tests. Discussion :  H. pylori was (at least) less commonly present before 6 months. It is possible that H. pylori , although nearly always present after 6 months, is not present at the onset of the disease. Confirmation of this finding would imply that infection with the organism is not the cause of duodenal ulceration, but a factor producing recurrence and chronicity.