Background factors of idiopathic peptic ulcers and optimal treatment methods: A multicenter retrospective Japanese study

Idiopathic peptic ulcer poses a clinical challenge since it is more frequently associated with underlying disease, especially atherosclerosis and liver cirrhosis with portal hypertension, is more refractory, with a higher recurrence rate than simple Helicobacter pylori-positive ulcers. This large-scale study investigated the trends in idiopathic peptic ulcers, examined the characteristics of refractory idiopathic peptic ulcer, and identified the optimal treatment. The characteristics of 309 patients with idiopathic peptic ulcer from 24 facilities throughout Japan were examined. We allocated idiopathic peptic ulcers that did not heal after 8 weeks' treatment (6 weeks for duodenal ulcers) to the refractory group and those that healed within this period to the healed group. The typical risk factors for idiopathic peptic ulcer (atherosclerosis-related underlying disease or liver cirrhosis complications) were absent in 46.6% of patients. Absence of gastric mucosal atrophy (refractory group: 51.4%, healed group: 28.4%; p=0.016), and gastric fundic gland polyps (refractory group: 17.6%, healed group: 5.9%; p=0.045) were significantly more common in the refractory group compared to the healed group. A history of H. pylori eradication (refractory group: 85.3%, healed group: 66.0%; p=0.016), previous H. pylori infection (i.e., gastric mucosal atrophy or history of H. pylori eradication) (refractory group: 48.5%, healed group: 80.0%; p=0.001), and potassium-competitive acid blocker treatment (refractory group: 28.6%, healed group, 64.1%; p=0.001) were significantly more frequent in the healed group compared to the refractory group. Thus, acid hypersecretion may be a major factor underlying the refractoriness of idiopathic peptic ulcer and potassium-competitive acid blocker is useful for initial treatment.