Silent peptic ulcer disease: frequency, factors leading to 'silence,' and implications regarding the pathogenesis of visceral symptoms

Background Peptic ulcer disease may occur in the absence of dyspeptic symptoms. The pathogenesis of dyspepsia in peptic ulcer disease is unclear. Whether the presence of Helicobacter pylori infection or use of non-steroidal anti-inflammatory drugs affects dyspeptic symptoms in patients with peptic ulcer disease has not been determined. The aim of the study was to determine the frequency and risk factors for peptic ulcer disease in a cohort of asymptomatic, unselected patients undergoing routine screening EGD. Methods This was a prospective study of a cohort of Chinese subjects undergoing screening EGD as part of a routine health maintenance program. Routine EGD screening was performed in 6457 consecutive subjects who underwent a self-paid, health evaluation. Those with endoscopy-confirmed peptic ulcer disease were enrolled to assess the risk factors that distinguish asymptomatic patients with peptic ulcer disease from patients with symptoms because of peptic ulcer disease. Results A total of 704 (10.9%) patients were found to have peptic ulcer disease, of which two thirds (n=496) were asymptomatic. Both uni- and multivariate analysis showed that the asymptomatic patients tended to have a larger body mass index, to be habitual tea drinkers, and to have an ulcer that was less than 1 cm in diameter and in a healing stage. Gender, blood group, history of hypertension and/or diabetes, ulcer location, Helicobacter pylori status, use of non-steroidal anti-inflammatories or sedative medications, habitual coffee drinking, and habits with respect to smoking of tobacco or ingestion of alcohol, had no association with symptoms. Conclusions The results of this study suggest that silent peptic ulcer disease is common in Taiwan. Dyspeptic symptoms because of peptic ulcer disease may be influenced by intrinsic (body mass index and ulcer characters) and extrinsic (habitual tea drinking) factors. Non-steroidal anti-inflammatory drug use and Helicobacter pylori status had no significant effect on the symptomatology of peptic ulcer disease. These findings may contribute to the understanding of the pathogenesis in the visceral symptoms of peptic ulcer disease.