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As the prevalence of Helicobacter pylori infection has decreased, the incidence of idiopathic duodenal ulcers (those not associated with H. pylori infection or nonsteroidal anti-inflammatory drugs [NSAIDs]) has increased. However, some of these so-called idiopathic ulcers might be attributable to duodenal infections that are missed by current H. pylori tests — urease evaluations, biopsies, and breath tests — all of which are designed to detect gastric mucosal infection.
To evaluate this possibility, investigators in Italy evaluated 608 consecutive patients with duodenal ulcers that were diagnosed by endoscopy. Patients taking NSAIDs were excluded. All patients had biopsy specimens taken from their gastric antrums, gastric bodies, and duodena…