Choroba wrzodowa żołądka i dwunastnicy

Choroba wrzodowa żołądka i dwunastnicy
Epidemiologia

Choroba wrzodowa żołądka i dwunastnicy (PUD) pozostaje istotnym problemem zdrowotnym globalnie, z dożywotnim ryzykiem rozwoju wynoszącym 5-10% i roczną zapadalnością 0,1-0,3%. Zakażenie Helicobacter pylori jest głównym czynnikiem etiologicznym, odpowiadając za około 90% wrzodów dwunastnicy i 70-90% wrzodów żołądka, a roczna zapadalność u zakażonych wynosi około 1%, co jest 6-10-krotnie wyższe niż u osób niezakażonych. Epidemiologia PUD wykazuje znaczne zróżnicowanie geograficzne i demograficzne, z wyższą częstością w krajach o niskim statusie społeczno-ekonomicznym i w regionach o wysokim rozpowszechnieniu H. pylori. W 2019 roku globalne rozpowszechnienie choroby wynosiło około 8,09 miliona przypadków, ze standaryzowanym wiekowo wskaźnikiem 99,40 na 100 000 populacji, co oznacza spadek w porównaniu z 1990 rokiem. Mimo ogólnego spadku zapadalności i śmiertelności (spadek wskaźnika umieralności o 59% do 3,0/100 000 w 2019 r.), obserwuje się stabilność częstości powikłań, takich jak krwawienia (15% pacjentów, zapadalność 19-57/100 000/rok) i perforacje (śmiertelność 10-40%). Czynniki ryzyka powikłań obejmują stosowanie NLPZ, wiek, płeć męską, choroby współistniejące oraz leki immunosupresyjne.

Epidemiologia choroby wrzodowej żołądka i dwunastnicy

Częstotliwość występowania i rozpowszechnienie
Związek z zakażeniem Helicobacter pylori
Trendy czasowe w epidemiologii choroby wrzodowej
Różnice demograficzne
Różnice geograficzne
Powikłania i obciążenie systemów opieki zdrowotnej
Choroby współistniejące i czynniki ryzyka
Nadzór i jakość opieki
Specyficzne grupy pacjentów

Podsumowanie trendów epidemiologicznych w chorobie wrzodowej

Kolejne rozdziały

Epidemiologia choroby wrzodowej żołądka i dwunastnicy

Choroba wrzodowa żołądka i dwunastnicy (peptic ulcer disease, PUD) pozostaje istotną przyczyną zachorowalności, śmiertelności oraz kosztów opieki zdrowotnej na całym świecie. W przeciągu ostatnich dekad zaobserwowano znaczące zmiany w epidemiologii tej choroby, co jest związane z wieloma czynnikami, w tym z rozpowszechnieniem zakażenia Helicobacter pylori, stosowaniem niesteroidowych leków przeciwzapalnych (NLPZ) oraz poprawą warunków higienicznych.¹²

Częstotliwość występowania i rozpowszechnienie

Globalne dożywotnie ryzyko rozwoju choroby wrzodowej wynosi od 5% do 10%, a roczna zapadalność szacowana jest na poziomie 0,1-0,3% populacji ogólnej.¹² W przeglądzie systematycznym obejmującym 31 opublikowanych badań, łączna zapadalność na niepowikłaną chorobę wrzodową wynosiła około jednego przypadku na 1000 osobolat w populacji ogólnej, natomiast częstość występowania powikłań wrzodowych oszacowano na około 0,7 przypadku na 1000 osobolat.¹²

W 2019 roku globalne rozpowszechnienie choroby wrzodowej wynosiło około 8,09 miliona przypadków, co stanowi wzrost o 25,82% w porównaniu z rokiem 1990. Jednocześnie standaryzowany wiekowo wskaźnik rozpowszechnienia wynosił 99,40 na 100 000 populacji w 2019 roku, co oznacza spadek o 143,37 na 100 000 populacji w porównaniu z 1990 rokiem.¹

W Stanach Zjednoczonych choroba wrzodowa dotyka około 4,6 miliona osób rocznie, a szacuje się, że około 10% populacji USA ma dowody przebytego owrzodzenia dwunastnicy w pewnym momencie życia.¹ W Europie zapadalność na chorobę wrzodową różni się znacząco między krajami. Badanie z 2018 roku wykazało, że Hiszpania miała najwyższą roczną zapadalność na chorobę wrzodową (141,8/100 000 osób), podczas gdy Wielka Brytania miała najniższą (23,9/100 000 osób).¹

Związek z zakażeniem Helicobacter pylori

Częstość występowania i rozpowszechnienie choroby wrzodowej różni się w zależności od obecności zakażenia Helicobacter pylori. Wyższe wskaźniki obserwuje się w krajach, gdzie zakażenie H. pylori jest częstsze.¹ Zakażenie H. pylori odpowiada za około 90% wrzodów dwunastnicy i 70-90% wrzodów żołądka.¹

Roczna zapadalność na chorobę wrzodową u osób zakażonych H. pylori wynosi około 1%, co stanowi wskaźnik 6-10 razy wyższy niż u osób niezakażonych.¹ W badaniu przeprowadzonym w Stanach Zjednoczonych endoskopowa częstość występowania wrzodów trawiennych u bezobjawowych, H. pylori-pozytywnych dorosłych wynosiła 2%.¹

W krajach zasobnych w badaniach systematycznych wykazano, że roczna częstość występowania choroby wrzodowej na podstawie diagnozy lekarskiej wynosi 0,1-1,5%, a na podstawie danych hospitalizacyjnych 0,1-0,19%.¹²

W krajach rozwijających się rozpowszechnienie zakażenia H. pylori może sięgać nawet 90%, co przyczynia się do wyższej częstości występowania choroby wrzodowej.¹ Różnice w rozpowszechnieniu H. pylori mogą wynikać z czynników takich jak większy rozmiar rodziny, niski status społeczno-ekonomiczny, przeludnienie, złe warunki sanitarne, posiadanie zakażonego rodzeństwa, opóźnienie wzrostu i niedobory żywieniowe, szczególnie niedokrwistość z niedoboru żelaza w krajach o niskim statusie społeczno-ekonomicznym.¹

Trendy czasowe w epidemiologii choroby wrzodowej

W ciągu ostatnich kilku dekad zaobserwowano ogólny spadek częstości występowania choroby wrzodowej na całym świecie, co jest przypisywane poprawie warunków higienicznych i sanitarnych, skutecznemu leczeniu oraz rozważnemu stosowaniu NLPZ.¹² Szczególnie wyraźny spadek zaobserwowano w krajach o wysokich dochodach ze względu na zwiększenie dostępności placówek szpitalnych i wprowadzenie nowych, skutecznych terapii.¹

Standaryzowany wiekowo wskaźnik zapadalności na chorobę wrzodową zmniejszył się o prawie 68% w regionie andyjskiej Ameryki Łacińskiej, o 56% w Ameryce Łacińskiej i na Karaibach oraz o 45% w Europie Wschodniej.¹ Standaryzowany wiekowo wskaźnik umieralności z powodu choroby wrzodowej zmniejszył się o 59%, z 7,4 w 1990 roku do 3,0 w 2019 roku.²

Pomimo ogólnego spadku zapadalności na chorobę wrzodową, w ostatnich 15 latach zaobserwowano stopniowy wzrost trendu, co może być związane ze zmianami w czynnikach ryzyka tej choroby, w tym z powszechnym stosowaniem NLPZ.¹ Dodatkowo, choć częstość występowania niepowikłanej choroby wrzodowej maleje, częstość występowania powikłań wrzodów żołądka i hospitalizacji pozostaje stabilna, częściowo ze względu na jednoczesne stosowanie kwasu acetylosalicylowego w starzejącej się populacji.¹

Różnice demograficzne

Występowanie choroby wrzodowej różni się w zależności od wieku, płci i położenia geograficznego. Częstość występowania owrzodzeń wzrasta z wiekiem zarówno w przypadku wrzodów dwunastnicy, jak i wrzodów żołądka. Jednakże częstość występowania niepowikłanej choroby wrzodowej osiąga plateau wraz z wiekiem, podczas gdy częstość występowania powikłanej choroby wrzodowej wzrasta z wiekiem.¹²

Historycznie, choroba wrzodowa częściej występowała u mężczyzn, jednak w ostatnich latach obserwuje się zmianę tego trendu. Dożywotnie rozpowszechnienie wynosi około 11-14% u mężczyzn i 8-11% u kobiet.¹ Trendy wiekowe dla występowania wrzodów ujawniają malejące wskaźniki u młodszych mężczyzn, szczególnie w przypadku wrzodów dwunastnicy, oraz rosnące wskaźniki u starszych kobiet.²

Globalny wskaźnik dysproporcji płci był bliski jedności i wahał się od 0,97 do 1,03 w 100 z 204 krajów.¹ Jednak ogólnie wrzody dwunastnicy są cztery razy częstsze niż wrzody żołądka i częściej występują u mężczyzn niż u kobiet.¹

Różnice geograficzne

Występowanie choroby wrzodowej różni się znacząco między regionami geograficznymi. W 2019 roku region Azji Południowej miał najwyższy standaryzowany wiekowo wskaźnik rozpowszechnienia.¹ Wśród krajów, Kiribati miało najwyższy standaryzowany wiekowo wskaźnik rozpowszechnienia w 2019 roku.²

Standaryzowane wiekowo wskaźniki rozpowszechnienia w kwintylach o wysokim i niskim SDI (Wskaźnik Rozwoju Społecznego) wynosiły odpowiednio 80,98 i 145,35 na 100 000 populacji w 2019 roku.¹ Kwintyl o wysokim SDI był związany z najniższym standaryzowanym wiekowo wskaźnikiem zgonów w 2019 roku, podczas gdy kwintyl o niskim SDI miał drugi najwyższy wskaźnik.²

W krajach zachodnich odsetek osób z zakażeniem H. pylori w przybliżeniu odpowiada wiekowi (tj. 20% w wieku 20 lat, 30% w wieku 30 lat, 80% w wieku 80 lat, itd.). Rozpowszechnienie jest wyższe w krajach trzeciego świata, gdzie szacuje się, że wynosi 70% populacji, podczas gdy w krajach rozwiniętych wskaźnik ten wynosi maksymalnie 40%.¹

Powikłania i obciążenie systemów opieki zdrowotnej

Powikłania choroby wrzodowej stanowią istotne obciążenie dla systemów opieki zdrowotnej. Krwawienie jest obecnie najczęstszym powikłaniem choroby wrzodowej, które dotyka do 15% pacjentów (zapadalność 19-57 przypadków/100 000 osób/rok), przy czym stosowanie NLPZ jest kluczowym czynnikiem ryzyka.¹

Częstość występowania perforowanego wrzodu trawiennego (PPU) jest stosunkowo rzadka, ale stanowi zagrożenie dla życia, a śmiertelność waha się od 10 do 40%. Wskaźnik zapadalności na PPU był w dużej mierze stabilny w Europie Północnej przez dziesięciolecia, z rocznym wskaźnikiem zapadalności wynoszącym około 4-11 na 100 000 rocznie.¹

Niedrożność odźwiernika (GOO) stanowi obecnie rzadkie powikłanie choroby wrzodowej, z częstością występowania wynoszącą 2%, w 80% przypadków wtórną do bliznowacenia z powodu przedłużającego się zapalenia w nieleczonych lub długotrwałych owrzodzeniach opuszki dwunastnicy.²

Szacowane bezpośrednie koszty opieki nad pacjentem i pośrednie koszty spowodowane utratą pracy i produktywności z powodu choroby wrzodowej wynoszą 6 miliardów dolarów rocznie w samych Stanach Zjednoczonych.¹ Choroba wrzodowa dotyka około 4,5 miliona osób rocznie w Stanach Zjednoczonych i generuje ogromne koszty opieki zdrowotnej wynoszące około 3,3 miliarda dolarów rocznie.¹

Choroby współistniejące i czynniki ryzyka

Pacjenci z chorobą wrzodową przyjmowani do szpitali w ostatnich dekadach mają coraz więcej chorób współistniejących, co odzwierciedlają wyższe wartości indeksu chorób współistniejących Charlsona i klasy ASA.¹ Śmiertelność krótkoterminowa jest związana z wynikiem ASA, co potwierdza zrozumienie, że choroby współistniejące pacjenta wpływają na śmiertelność.²

Czynniki ryzyka związane z rozwojem powikłań choroby wrzodowej obejmują płeć męską, zaawansowany wiek, choroby współistniejące, alkohol, palenie tytoniu, stosowanie NLPZ, leczenie przeciwkrzepliwe, kortykosteroidy i leki immunosupresyjne.¹ Śmiertelność zwiększa się z wiekiem i chorobami współistniejącymi i jest wyższa u pacjentów bez wcześniejszej historii choroby wrzodowej.¹

Badania wykazały również związek między zdrowiem psychicznym a chorobą wrzodową. W koreańskiej populacji osoby z problemami zdrowia psychicznego były bardziej narażone na wyższe rozpowszechnienie choroby wrzodowej, niezależnie od ich wieku, czynników społeczno-ekonomicznych i chorób ogólnoustrojowych w modelach dostosowanych do wielu zmiennych.¹

Nadzór i jakość opieki

Badanie Global Burden of Disease, Injuries and Risk Factors (GBD) dostarcza kompleksowych epidemiologicznych szacunków rozpowszechnienia, zapadalności, lat życia skorygowanych niesprawnością (DALY) i śmiertelności związanej z chorobami i urazami w określonych grupach krajów i terytoriów według płci, wieku i roku.¹

Globalny wskaźnik jakości opieki (QCI) dla choroby wrzodowej wynosił 72,6 w 1990 roku, co zwiększyło się o 14,6% do 83,2 w 2019 roku.¹² QCI w chorobie wrzodowej znacznie poprawił się w latach 1990-2019 na całym świecie. Istnieją jednak nadal znaczące różnice między krajami o różnych i podobnych poziomach SDI.²¹

QCI zwykle zmniejsza się wraz z wiekiem pacjentów, jednak różnica ta była bardziej znacząca wśród krajów o niskim SDI.¹ Różnica między najwyższym a najniższym QCI była węższa w 2019 roku niż w 1990 roku.²

Mimo dostępności skutecznych terapii, choroba wrzodowa pozostaje głównym globalnym problemem zdrowotnym, wynikającym z połączenia utrzymującego się zakażenia Helicobacter pylori i powszechnego stosowania niesteroidowych leków przeciwzapalnych.¹

Specyficzne grupy pacjentów

U pacjentów z chorobą nowotworową śmiertelność z powodu wrzodów trawiennych jest prawie dwukrotnie wyższa niż w ogólnej populacji USA. Standaryzowany współczynnik umieralności (SMR) wynosi 1,78 (95% przedział ufności, 1,73-1,84).¹ SMR różniły się w zależności od wieku w momencie diagnozy, rasy, płci, stanu cywilnego, roku diagnozy, stadium guza, rodzaju nowotworu, czasu obserwacji oraz tego, czy pacjenci przeszli operację lub radioterapię.¹

W populacji wojskowej oficerowie/żołnierze z wrzodami trawiennymi są diagnozowani w młodszym wieku. Mimo lepszych wyników, nawrót choroby wrzodowej może być częstszy ze względu na wyższe rozpowszechnienie zakażenia Helicobacter pylori i narażenie na stres.¹

W populacji dziecięcej choroba wrzodowa jest stosunkowo rzadka, z szacowaną częstością występowania 1 przypadek na 2500 przyjęć do szpitala w Stanach Zjednoczonych. Dane dla krajów rozwijających się, w tym Nigerii, są ograniczone, chociaż owrzodzenie trawienne jest coraz częściej rozpoznawane u dzieci w krajach rozwijających się.¹

Podsumowanie trendów epidemiologicznych w chorobie wrzodowej

Epidemiologia choroby wrzodowej żołądka i dwunastnicy charakteryzuje się wyraźnymi różnicami geograficznymi i czasowymi. Częstość występowania, rozpowszechnienie i śmiertelność z powodu wrzodów żołądka i dwunastnicy różnią się od czterech do dziesięciu razy między różnymi krajami europejskimi.¹

W ciągu ostatnich 20-30 lat liczba pacjentów, którzy zmarli z powodu choroby wrzodowej, którzy zostali poddani operacji, którzy zgłosili się do lekarzy lub byli hospitalizowani z powodu choroby wrzodowej, zmniejszyła się o ponad 100%. Zmiany te nastąpiły w tak krótkim czasie, że można wykluczyć podstawę genetyczną. Wydaje się więc prawdopodobne, że wynikają one ze zmian środowiskowych czynników ryzyka.²

Ogólnie, choć zapadalność i rozpowszechnienie choroby wrzodowej znacząco spadły w ciągu ostatnich kilku dekad, nierówności w dostępie do opieki zdrowotnej i jakości opieki w różnych regionach świata pozostają istotnym wyzwaniem. Poprawa jakości opieki, wczesna diagnostyka i odpowiednie leczenie, w tym eradykacja H. pylori, są kluczowe dla dalszego zmniejszania obciążenia chorobą wrzodową na całym świecie.¹²

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Materiały źródłowe

#1 Peptic ulcer disease: Epidemiology, etiology, and pathogenesis – UpToDate
https://www.uptodate.com/contents/peptic-ulcer-disease-epidemiology-etiology-and-pathogenesis
Peptic ulcer disease (PUD) remains an important cause of morbidity, mortality, and health care costs. […] In a systematic review of 31 published studies, the pooled incidence of uncomplicated PUD was approximately one case per 1000 person-years in the general population, and the incidence of ulcer complications was approximately 0.7 cases per 1000 person-years. […] The incidence and prevalence of PUD varies based upon the presence of Helicobacter pylori. Higher rates are found in countries where H. pylori infection is higher. […] The incidence of PUD in H. pylori-infected individuals is approximately 1 percent per year, a rate that is 6- to 10-fold higher than for uninfected individuals. […] A systematic review of seven studies from resource-abundant countries indicated a population-based one-year prevalence of PUD of 0.1 to 1.5 percent based on physician diagnosis and 0.1 to 0.19 percent based on hospitalization data.
#1 Peptic Ulcer Disease – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK534792/
Peptic ulcer disease (PUD) is a global problem with a lifetime risk of development ranging from 5% to 10%. […] Overall, there is a decrease in the incidence of PUD worldwide due to improved hygienic and sanitary conditions combined with effective treatment and judicious use of NSAIDs. […] Duodenal ulcers are four times more common than gastric ulcers. Also, duodenal ulcers are more common in men than in women.
#1 The global, regional and national burden of peptic ulcer disease from 1990 to 2019: a population-based study | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-022-02130-2
Peptic ulcer disease (PUD) is a common digestive disorder, of which the prevalence decreased in the past few decades. However, the decreasing tendency has plateaued in recent years due to changes in risk factors associated with the etiology of PUD, such as non-steroidal anti-inflammatory drug use. […] In this study, we investigated the epidemiological and the sociodemographic characteristics of PUD in 204 countries and territories from 1990 to 2019 based on data from the Global Burden of Disease, Injuries and Risk Factors (GBD) Study. […] In 2019, the global prevalence of PUD was approximately 8.09 million, representing a 25.82% increase from 1990. […] The age-standardized prevalence rate was 99.40 per 100,000 population in 2019, representing a decrease of 143.37 per 100,000 population from 1990.
#1 Peptic Ulcer Disease: Background, Anatomy, Pathophysiology
https://emedicine.medscape.com/article/181753-overview
The global incidence and prevalence of peptic ulcer disease, along with the associated rates of hospitalizations and mortality, have been in decline over the past couple of decades, attributed in part to the complex changes in the risk factors for peptic ulcer disease, including reductions in the prevalence of H pylori infection, the widespread use of antisecretory agents and nonsteroidal anti-inflammatory drugs (NSAIDs), and an aging population. […] In the United States, peptic ulcer disease affects approximately 4.6 million people annually, with an estimated 10% of the US population having evidence of a duodenal ulcer at some time. H pylori infection accounts for 90% of duodenal ulcers and 70%-90% of gastric ulcers. The proportion of people with H pylori infection and peptic ulcer disease increases steadily with age.
#1 Peptic Ulcer Disease: Background, Anatomy, Pathophysiology
https://emedicine.medscape.com/article/181753-overview
The frequency of peptic ulcer disease in other countries is variable and is determined primarily by association with the major causes of peptic ulcer disease: H pylori and NSAIDs. A 2018 systematic MEDLINE and PubMed review found Spain had the highest annual incidence of all peptic ulcer disease (141.8/100,000 persons), whereas the United Kingdom had the lowest (23.9/100,000 persons). When perforated peptic ulcer disease was assessed, South Korea had the highest annual incidence (4.4/100,000 persons) and the United Kingdom, again, had the lowest (2.2/100,000 persons).
#1 Peptic ulcer disease: Epidemiology, etiology, and pathogenesis – UpToDate
https://www.uptodate.com/contents/peptic-ulcer-disease-epidemiology-etiology-and-pathogenesis
A study in the United States reported an endoscopic point prevalence for peptic ulcers in asymptomatic, H. pylori-positive adults of 2 percent. […] Ulcer incidence increases with age for both duodenal ulcers (DUs) and gastric ulcers (GUs), but the incidence of uncomplicated PUD reached a plateau with age, whereas for complicated PUD, the incidence increases with age.
#1 Peptic Ulcer Disease | IntechOpen
https://www.intechopen.com/chapters/67428
Peptic ulcer disease (PUD) is one of the commonest diseases seen throughout the world. […] PUD affects about 4.5 million persons per year in the United States (US) and causes huge healthcare cost of about $3.3 billion/year. […] The prevalence of PUD varies with the prevalence of Helicobacter pylori (H. pylori) infection. […] In developing countries, the prevalence of infection can be as high as 90%. […] Systematic review of the literature from developed countries estimated that the global incidence and prevalence of physician-diagnosed PUD were 0.100.19% and 0.121.50%, respectively. […] But the incidence and prevalence of PUD have decreased with the universal use of acid suppressant therapy and decrease in prevalence of Helicobacter pylori infection due to improved socioeconomic status and eradication of H. pylori infection after detection.
#1 Quality of care of peptic ulcer disease worldwide: A systematic analysis for the global burden of disease study 1990â2019
https://pmc.ncbi.nlm.nih.gov/articles/PMC9342757/
The mortality of bleeding peptic ulcers remains higher among patients over 60 years of age, especially those over 80, despite previous advances in pharmacological and endoscopic treatment. […] The reasons for the witnessed heterogeneity could be larger family size, low socioeconomic status, overcrowding, poor sanitation, having an infected sibling, growth retardation, and nutritional deficiencies, particularly iron-deficiency anemia in low SDI countries.
#1 An Overview on Peptic Ulcer Disease, Diagnosis and Management Approach – Pharmacophore
https://pharmacophorejournal.com/article/an-overview-on-peptic-ulcer-disease-diagnosis-and-management-approach
Peptic ulcer disease is one of the most common complaints in the medical field. […] In the last 20-30 years, the incidence of the disease has shown a sharp decrease, and this phenomenon has been associated with the improvement of drug therapy and the increase of hospital facilities. […] Prevalence of peptic ulcer disease lifetime was about 5-10%, with the incidence of 0.1-0.3%. In the last 20-30 year, peptic ulcer incidence had been dropped especially in the high-income countries due to increasing of hospital facilities and the introduction of new and effective therapies. […] Peptic ulcer disease was very common in the past; nowadays, it is less common in high-income countries.
#1 Quality of care of peptic ulcer disease worldwide: A systematic analysis for the global burden of disease study 1990â2019
https://pmc.ncbi.nlm.nih.gov/articles/PMC9342757/
The global Gender Disparity Ratio was close to one and ranged from 0.97 to 1.03 in 100 of 204 countries. […] The age-standardized prevalence of PUD has decreased 31% worldwide, from 143.4 per 100,000 to 99.4 in 2019. […] The age-standardized incidence rate has decreased by almost 68% in Andean Latin America, 56% in Latin America and Caribbean, and 45% in Eastern Europe. […] The age-standardized mortality rate of PUD has 59% decreased, from 7.4 in 1990 to 3.0 in 2019. […] The highest age-standardized mortality of PUD was witnessed in low and low-middle SDI countries. […] There was heterogeneity among the QCI level of countries with the same SDI level. […] The gap between the highest and lowest QCI was narrower in 2019 than in 1990. […] The QCI typically decreases as people age; however, this gap was more significant among low-SDI countries.
#1 Peptic Ulcer Disease: Background, Anatomy, Pathophysiology
https://emedicine.medscape.com/article/181753-overview
Overall, the incidence of duodenal ulcers has been decreasing over the past 3-4 decades. Although the rate of simple gastric ulcer is in decline, the incidence of complicated gastric ulcer and hospitalization has remained stable, partly due to the concomitant use of aspirin in an aging population. […] The prevalence of peptic ulcer disease has shifted from predominance in males to similar occurrences in males and females. The lifetime prevalence is approximately 11%-14% in men and 8-11% in women. Age trends for ulcer occurrence reveal declining rates in younger men, particularly for duodenal ulcer, and increasing rates in older women. […] In a systematic search of PubMed, EMBASE, and the Cochrane library, the annual incidence rates of peptic ulcer disease were found to be 0.10-0.19% for physician-diagnosed peptic ulcer disease and 0.03-0.17% when based on hospitalization data. The 1-year prevalence based on physician diagnosis was 0.12-1.50% and that based on hospitalization data was 0.10-0.19%. The majority of studies reported a decrease in the incidence or prevalence of peptic ulcer disease over time.
#1 The global, regional and national burden of peptic ulcer disease from 1990 to 2019: a population-based study | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-022-02130-2
The age-standardized DALY rate in 2019 was decreased by 60.64% compared to that in 1990. […] Regionally, South Asia had the highest age-standardized prevalence rate in 2019. […] A low age-standardized death rate was found in the high-income super-region. […] Among nations, Kiribati had the highest age-standardized prevalence rate in 2019. […] Morbidity and mortality due to PUD decreased significantly from 1990 to 2019, while a gradual upward inclination has been observed in recent 15 years, which might be associated with changes in risk factors for PUD. […] Our study aims to investigate the current landscape and changes in the epidemiological characteristics of PUD to support healthcare-associated policy makers in developing improved PUD prevention strategies. […] The GBD study provides comprehensive epidemiological estimates of the prevalence of, incidence of, disability-adjusted life years (DALYs) due to, and mortality associated with diseases and injuries across specific groups of countries and territories by sex, age and year.
#1 The global, regional and national burden of peptic ulcer disease from 1990 to 2019: a population-based study | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-022-02130-2
The age-standardized prevalence rates in the high-SDI and low-SDI quintiles were 80.98 and 145.35 per 100,000 population in 2019, respectively. […] The high-SDI quintile was associated with the lowest age-standardized death rate in 2019, while the low-SDI quintile had the second-highest rate. […] In conclusion, this study focused on the epidemiological characteristics of PUD in different countries and territories, different age groups and different sexes. Overall, the risk of morbidity and mortality due to PUD decreased significantly, but with the passage of time for H. pylori eradication, the downward trend gradually weakened, which might be related to the gradual shift in the main risk factors for PUD from H. pylori infection to wide use of NSAIDs.
#1 Peptic ulcer disease – Wikipedia
https://en.wikipedia.org/wiki/Peptic_ulcer_disease
The lifetime risk for developing a peptic ulcer is approximately 5% to 10% with the rate of 0.1% to 0.3% per year. Peptic ulcers resulted in 301,000 deaths in 2013, down from 327,000 in 1990. […] In Western countries, the percentage of people with H. pylori infections roughly matches age (i.e., 20% at age 20, 30% at age 30, 80% at age 80, etc.). Prevalence is higher in third world countries, where it is estimated at 70% of the population, whereas developed countries show a maximum of a 40% ratio. Overall, H. pylori infections show a worldwide decrease, more so in developed countries. […] Peptic ulcer disease had a tremendous effect on morbidity and mortality until the last decades of the 20th century when epidemiological trends started to point to an impressive fall in its incidence. The reason that the rates of peptic ulcer disease decreased is thought to be the development of new effective medication and acid suppressants and the rational use of nonsteroidal anti-inflammatory drugs (NSAIDs).
#1 Non-perforated peptic ulcer disease: multidetector CT findings, complications, and differential diagnosis | Insights into Imaging | Full Text
https://insightsimaging.springeropen.com/articles/10.1007/s13244-017-0562-5
Mortality increases with age and comorbidities, and is higher in patients without previous history of PUD. […] Bleeding is nowadays the most common PUD complication, which affects up to 15% of patients (incidence 1957 cases/100.000 individuals/year) with NSAID use as key risk factor. […] Despite effective treatment, PUD-related haemorrhage tends to recur and up to 31% of patients will experience rebleeding within a month. […] Gastric outlet obstruction (GOO) refers to blocked passage of gastric contents into the duodenum from a partial or complete obstacle located at the distal stomach, pylorus, or duodenal bulb. […] Currently, obstruction represents an uncommon PUD complication with a 2% incidence, in 80% of cases secondary to scarring from prolonged inflammation in untreated or long-standing bulbar ulcers. […] Contrary to intraperitoneal perforation, which causes free peritonitis in the abdominal cavity, posterior duodenal ulcers may occasionally penetrate into the retroperitoneum or fistulise to adjacent organs such as the pancreas, common bile duct, gallbladder or liver.
#1 Epidemiology of perforated peptic ulcer: Age- and gender-adjusted analysis of incidence and mortality
https://www.wjgnet.com/1007-9327/full/v19/i3/347.htm
Epidemiology of perforated peptic ulcer: Age- and gender-adjusted analysis of incidence and mortality. Each year peptic ulcer disease (PUD) affects 4 million people around the world. Complications are encountered in 10%-20% of these patients and 2%-14% of the ulcers will perforate. Perforated peptic ulcer (PPU) is a quite rare, but life threatening disease and the mortality varies from 10%-40%. The incidence rate of PPU has, with some fluctuations, been fairly stable in Northern Europe for decades with reported annual incidence rates of about 4-11 per 100000 per year. Due to the high mortality and morbidity rates from PPU, it is of importance to understand the epidemiology to, if possible, enable preventive measures. The adjusted incidence rate for the overall 10-year period was 6.5 per 100000 per year (95%CI: 5.6-7.6) and the adjusted mortality rate for the overall 10-year period was 1.1 per 100000 per year (95%CI: 0.7-1.6). A non-significant decline in adjusted incidence rate from 9.7 to 5.6 occurred during the decade. The standardized mortality ratio for the whole study period was 5.7 (95%CI: 3.9-8.2), while the total 30-d mortality was 16.3%. The adjusted incidence rates in the first decade of the 21st century was stable and reflected the decline seen towards the end of the 20th century. Perforated peptic ulcer continues to present outside regular work-hours in over half the time and frequently during weekends, with little difference in seasonal distribution. Mortality is unchanged and stable and is most considerable in the aged population.
#1
https://www.cdc.gov/mmwr/preview/mmwrhtml/00049679.htm
An estimated 25 million persons in the United States have had peptic ulcer disease (PUD) during their lifetimes. A high proportion (at least 90%) of PUD cases are caused by infection with Helicobacter pylori — an association first reported in 1983. However, in 1995, most (72%) of the general public was unaware of this association. The findings indicate that only 27% of the general public is aware of the association between H. pylori infection and PUD. PUD is the primary reported cause of death in approximately 6500 persons in the United States each year. The estimated direct costs of patient care and indirect costs caused by work and productivity loss for PUD are $6 billion annually. The findings of the survey described in this report are consistent with those of the population-based survey in 1995 and confirm limited awareness among the general population about H. pylori infection as a treatable cause of PUD. CDC, in collaboration with partner organizations, has developed a national campaign to increase awareness among and educate the general public and the medical community about the association between H. pylori infection and PUD.
#1 Epidemiology of perforating peptic ulcer: A population-based retrospective study over 40 years
https://www.wjgnet.com/1007-9327/full/v26/i35/5302.htm
Epidemiology of perforating peptic ulcer: A population-based retrospective study over 40 years. The incidence of peptic ulcer disease has decreased during the last few decades, but the incidence of reported peptic ulcer complications has not decreased. Perforating peptic ulcer (PPU) is a severe form of the disease. To assess trends in the incidence, presentation, and outcome of PPU over a period of 40 years. This was a single-centre, retrospective, cohort study of all patients admitted to Levanger Hospital, Norway, with PPU from 1978 to 2017. The incidence of PPU was analysed using Poisson regression with perforated ulcer as the dependent variable, and sex, age, and calendar year from 1978 to 2017 as covariates. Declining incidence rates occurred in recent years, but the patients were older and had more comorbidity. The ASA score was associated with both short-term mortality and long-term survival. The incidence of peptic ulcer disease (PUD) has decreased during the last few decades. However, the incidence of peptic ulcer complications has not decreased in the same manner. The incidence of PPU was defined as the number of new cases of PPU in the defined population within 1 year. The incidence rate (IR) was defined as the incidence divided by the total person-time at risk during the same year. The IR increased significantly with age for both gastric and duodenal PPUs. The IR tended to decline during the last half of the observation period, and this tendency occurred almost one decade earlier for men than women. The patients admitted with PPU had increasing comorbidity in recent decades according to the Charlson Comorbidity Index and ASA class. Increasing age and greater comorbidity in the patients treated for PPU could explain the increase in serious complications. The short-term mortality was associated with ASA score, supporting the understanding that patient comorbidity affects mortality.
#1 Non-perforated peptic ulcer disease: multidetector CT findings, complications, and differential diagnosis | Insights into Imaging | Full Text
https://insightsimaging.springeropen.com/articles/10.1007/s13244-017-0562-5
Despite availability of effective therapies, peptic ulcer disease (PUD) remains a major global disease, resulting from a combination of persistent Helicobacter pylori infection and widespread use of nonsteroidal anti-inflammatory drugs. […] PUD continues to be a major global health issue that affects roughly 10% of the world population, due to the combined effect of persistent HP epidemics in low-income countries and of widespread use of nonsteroidal anti-inflammatory drugs (NSAIDs). […] Currently, digestive bleeding is by far the commonest complication, followed by perforation, gastric outlet obstruction and fistulisation, in descending order of frequency. […] Risk factors associated with development of PUD complications include male sex, advanced age, comorbidities, alcohol, smoking, NSAID use, anticoagulation, corticosteroids and immunosuppressant medications.
#1 The analysis of risk for peptic ulcer disease using Korean national health and nutrition examination survey: a cross-sectional analysis of a national survey sample
https://atm.amegroups.org/article/view/39788/html
To evaluate the risk factors associated with the incidence of peptic ulcer disease (PUD), study was conducted to assess the relationship between socioeconomic and environmental factors and PUD in a large scales data of the Korean population using the Korea National Health and Nutrition Examination Survey (KNHANES). […] KNHANES is a national surveillance system that collects the health and nutritional status of Koreans since 1998. […] We demonstrated significant association between mental health and PUD in a nationally representative sample of Korean population. […] Despite limitation, present study offers new information that Koreans who have mental health problem were more likely to have a higher prevalence of PUD regardless of their age, socioeconomic factors, systemic conditions in multivariable adjusted models. […] In conclusion, in Korean, mental health is associated with an increased prevalence of PUD.
#1 Quality of care of peptic ulcer disease worldwide: A systematic analysis for the global burden of disease study 1990â2019
https://pmc.ncbi.nlm.nih.gov/articles/PMC9342757/
Peptic ulcer disease (PUD) affects four million people worldwide annually and has an estimated lifetime prevalence of 5-10% in the general population. […] Worldwide, there are significant heterogeneities in coping approaches of healthcare systems with PUD in prevention, diagnosis, treatment, and follow-up. […] Quantifying and benchmarking health systems performance is crucial yet challenging to provide a clearer picture of the potential global inequities in the quality of care. […] The objective of this study was to compare the health-system quality-of-care and inequities for PUD among age groups and sexes worldwide. […] Global QCI was 72.6 in 1990, which increased by 14.6% to 83.2 in 2019. […] QCI of PUD improved dramatically during 1990-2019 worldwide. […] There are still significant heterogeneities among countries on different and similar SDI levels.
#1 Quality of care of peptic ulcer disease worldwide: A systematic analysis for the global burden of disease study 1990â2019 | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0271284
Peptic ulcer disease (PUD) affects four million people worldwide annually and has an estimated lifetime prevalence of 510% in the general population. […] Worldwide, there are significant heterogeneities in coping approaches of healthcare systems with PUD in prevention, diagnosis, treatment, and follow-up. […] Quantifying and benchmarking health systems performance is crucial yet challenging to provide a clearer picture of the potential global inequities in the quality of care. […] The objective of this study was to compare the health-system quality-of-care and inequities for PUD among age groups and sexes worldwide. […] Global QCI was 72.6 in 1990, which increased by 14.6% to 83.2 in 2019. […] QCI of PUD improved dramatically during 19902019 worldwide. There are still significant heterogeneities among countries on different and similar SDI levels.
#1 Incidence and characteristics of death from peptic ulcer among cancer patients in the United States | Scientific Reports
https://www.nature.com/articles/s41598-021-00602-1
Most cancer patients die of non-cancer causes, and peptic ulcer is one cause that deserves attention. To characterize the incidence and risk factors of death from peptic ulcer among cancer patients, we extracted the data of cancer patients registered in the Surveillance Epidemiology and End Results (SEER) program from 1975 to 2016. Out of the 8,471,051 patients extracted from SEER, 4,698 died from peptic ulcer, with a mortality rate of 9.08/100,000 person-years. Meanwhile, the mortality rate in the general population was 5.09/100,000 person-years, giving a standardized mortality ratio (SMR) of 1.78 (95% confidence interval, 1.731.84). […] The incidence of peptic ulcer death in cancer survivors was nearly twice that in the general US population. This was the first study to assess the risk of death due to peptic ulcers, independent of the cancer site and treatment approach. Our data demonstrated that peptic ulcer is one of the non-cancer causes of death among cancer survivors and accounts for a certain proportion. As such, it deserves the attention of clinicians, especially oncologists and gastroenterologists.
#1 Incidence and characteristics of death from peptic ulcer among cancer patients in the United States | Scientific Reports
https://www.nature.com/articles/s41598-021-00602-1
The SMRs varied with the age at diagnosis, race, sex, marital status, year of diagnosis, tumor stage, types of cancer, follow-up time, and whether the patients had undergone surgery or radiotherapy. The SMRs were highest in the first year following diagnosis for most tumor types and were significantly higher among patients with upper digestive system malignancies than among those with other types of cancer 10 years after diagnosis. Additionally, both the SMRs and HRs of peptic ulcer mortality were higher in survivors with upper gastrointestinal system malignancies than in those with other cancers. Notably, the elevated risk could be attributed to gastrointestinal toxicity from radiotherapy due to the high radiosensitivity of the gastroduodenum, which deserves attention in the survivorship management of cancer patients.
#1 Characteristics of peptic ulcer in military officers/soldiers: a preliminary analysis – Song – AME Medical Journal
https://amj.amegroups.org/article/view/4558/html
On the basis of such a preliminary study, we could identify the characteristics of military officers/soldiers with peptic ulcers. Military officers/soldiers are diagnosed with peptic ulcers when they are younger. In spite of better outcomes, we would like to indicate that the recurrence of peptic ulcer might be more common due to a higher prevalence of Helicobacter pylori infection and stress exposure.
#1
https://www.msjonline.org/index.php/ijrms/article/view/10640
A peptic ulcer is a sore on the inner lining of the stomach or duodenum, caused mainly by non-steroidal anti-inflammatory drugs and Helicobacter pylori infection. […] In childhood, peptic ulcer disease (PUD) is an uncommon disease, with an estimated frequency of 1 case in 2, 500 hospital admissions in the United States. […] Data for developing countries, including Nigeria, are scarce, although peptic ulceration is being increasingly recognized in children in the developing world now. […] The prevalence of PUD was 16%; 8.3% in females and 7.6% in males. […] In the 2-6 years age group prevalence was 7%, while in the 7-11 years age group it was 9%. […] Association between sex and prevalence of PUD was not significant (p=0.62), but very significant for that with age (p=0.0003). […] Prevalence of PUD was 16%. This increased with age (7% in the 2-6 years age group and 9% in the 7-11 years group). […] To address the rising prevalence of PUD in these children, there is need to monitor their feeding habits in school, besides teaching them the importance of personal hygiene.
#1 Epidemiology of peptic ulcer disease | SpringerLink
https://link.springer.com/chapter/10.1007/978-94-009-1245-8_1
The epidemiology of both gastric and duodenal ulcer is characterized by marked geographic and temporal variations. The incidence, prevalence and mortality of gastric and duodenal ulcer vary four- to ten-fold among different European countries. […] During the past 2030 years the number of patients who died from peptic ulcer disease, who have been operated upon, who saw physicians or were hospitalized for peptic ulcer disease have decreased by more than 100 per cent. These changes occurred within so short a period that a genetic basis can be ruled out. Thus, it seems likely that they stem from changes in environmental risk factors. The geographic variability of ulcer prevalence among populations of similar ethnicity and comparable medical standards also hints at environmental influences. Judging from their effect, it appears that environmental factors are of sufficient magnitude to constitute a fertile ground for inquiry because such information would engender the development of potent measures for prevention and treatment of gastric and duodenal ulcer disease. In addition, knowledge of environmental risk factors could provide new insights and methods to study the pathophysiology of peptic ulcer.
#2 Peptic Ulcer Disease – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK534792/
Peptic ulcer disease (PUD) is a global problem with a lifetime risk of development ranging from 5% to 10%. […] Overall, there is a decrease in the incidence of PUD worldwide due to improved hygienic and sanitary conditions combined with effective treatment and judicious use of NSAIDs. […] Duodenal ulcers are four times more common than gastric ulcers. Also, duodenal ulcers are more common in men than in women.
#2 Peptic Ulcer Disease
https://fpnotebook.com/GI/PUD/PptcUlcrDs.htm
Annual Incidence: 0.1 to 0.3% in western countries (1 case per 1000 person years) […] Worldwide lifetime Prevalence approaches 1 in 12 adults in the United States (5-10%)
#2 Peptic ulcer disease: Epidemiology, etiology, and pathogenesis – UpToDate
https://www.uptodate.com/contents/peptic-ulcer-disease-epidemiology-etiology-and-pathogenesis/print
Peptic ulcer disease (PUD) remains an important cause of morbidity, mortality, and health care costs. […] In a systematic review of 31 published studies, the pooled incidence of uncomplicated PUD was approximately one case per 1000 person-years in the general population, and the incidence of ulcer complications was approximately 0.7 cases per 1000 person-years. […] The incidence and prevalence of PUD varies based upon the presence of Helicobacter pylori. Higher rates are found in countries where H. pylori infection is higher. […] A systematic review of seven studies from resource-abundant countries indicated a population-based one-year prevalence of PUD of 0.1 to 1.5 percent based on physician diagnosis and 0.1 to 0.19 percent based on hospitalization data. […] Ulcer incidence increases with age for both duodenal ulcers (DUs) and gastric ulcers (GUs), but the incidence of uncomplicated PUD reached a plateau with age, whereas for complicated PUD, the incidence increases with age.
#2 Peptic Ulcer Disease: Background, Anatomy, Pathophysiology
https://emedicine.medscape.com/article/181753-overview
Overall, the incidence of duodenal ulcers has been decreasing over the past 3-4 decades. Although the rate of simple gastric ulcer is in decline, the incidence of complicated gastric ulcer and hospitalization has remained stable, partly due to the concomitant use of aspirin in an aging population. […] The prevalence of peptic ulcer disease has shifted from predominance in males to similar occurrences in males and females. The lifetime prevalence is approximately 11%-14% in men and 8-11% in women. Age trends for ulcer occurrence reveal declining rates in younger men, particularly for duodenal ulcer, and increasing rates in older women. […] In a systematic search of PubMed, EMBASE, and the Cochrane library, the annual incidence rates of peptic ulcer disease were found to be 0.10-0.19% for physician-diagnosed peptic ulcer disease and 0.03-0.17% when based on hospitalization data. The 1-year prevalence based on physician diagnosis was 0.12-1.50% and that based on hospitalization data was 0.10-0.19%. The majority of studies reported a decrease in the incidence or prevalence of peptic ulcer disease over time.
#2 An Overview on Peptic Ulcer Disease, Diagnosis and Management Approach – Pharmacophore
https://pharmacophorejournal.com/article/an-overview-on-peptic-ulcer-disease-diagnosis-and-management-approach
Peptic ulcer disease is one of the most common complaints in the medical field. […] In the last 20-30 years, the incidence of the disease has shown a sharp decrease, and this phenomenon has been associated with the improvement of drug therapy and the increase of hospital facilities. […] Prevalence of peptic ulcer disease lifetime was about 5-10%, with the incidence of 0.1-0.3%. In the last 20-30 year, peptic ulcer incidence had been dropped especially in the high-income countries due to increasing of hospital facilities and the introduction of new and effective therapies. […] Peptic ulcer disease was very common in the past; nowadays, it is less common in high-income countries.
#2 Quality of care of peptic ulcer disease worldwide: A systematic analysis for the global burden of disease study 1990â2019
https://pmc.ncbi.nlm.nih.gov/articles/PMC9342757/
The global Gender Disparity Ratio was close to one and ranged from 0.97 to 1.03 in 100 of 204 countries. […] The age-standardized prevalence of PUD has decreased 31% worldwide, from 143.4 per 100,000 to 99.4 in 2019. […] The age-standardized incidence rate has decreased by almost 68% in Andean Latin America, 56% in Latin America and Caribbean, and 45% in Eastern Europe. […] The age-standardized mortality rate of PUD has 59% decreased, from 7.4 in 1990 to 3.0 in 2019. […] The highest age-standardized mortality of PUD was witnessed in low and low-middle SDI countries. […] There was heterogeneity among the QCI level of countries with the same SDI level. […] The gap between the highest and lowest QCI was narrower in 2019 than in 1990. […] The QCI typically decreases as people age; however, this gap was more significant among low-SDI countries.
#2 The global, regional and national burden of peptic ulcer disease from 1990 to 2019: a population-based study | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-022-02130-2
The age-standardized DALY rate in 2019 was decreased by 60.64% compared to that in 1990. […] Regionally, South Asia had the highest age-standardized prevalence rate in 2019. […] A low age-standardized death rate was found in the high-income super-region. […] Among nations, Kiribati had the highest age-standardized prevalence rate in 2019. […] Morbidity and mortality due to PUD decreased significantly from 1990 to 2019, while a gradual upward inclination has been observed in recent 15 years, which might be associated with changes in risk factors for PUD. […] Our study aims to investigate the current landscape and changes in the epidemiological characteristics of PUD to support healthcare-associated policy makers in developing improved PUD prevention strategies. […] The GBD study provides comprehensive epidemiological estimates of the prevalence of, incidence of, disability-adjusted life years (DALYs) due to, and mortality associated with diseases and injuries across specific groups of countries and territories by sex, age and year.
#2 The global, regional and national burden of peptic ulcer disease from 1990 to 2019: a population-based study | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-022-02130-2
The age-standardized prevalence rates in the high-SDI and low-SDI quintiles were 80.98 and 145.35 per 100,000 population in 2019, respectively. […] The high-SDI quintile was associated with the lowest age-standardized death rate in 2019, while the low-SDI quintile had the second-highest rate. […] In conclusion, this study focused on the epidemiological characteristics of PUD in different countries and territories, different age groups and different sexes. Overall, the risk of morbidity and mortality due to PUD decreased significantly, but with the passage of time for H. pylori eradication, the downward trend gradually weakened, which might be related to the gradual shift in the main risk factors for PUD from H. pylori infection to wide use of NSAIDs.
#2 Non-perforated peptic ulcer disease: multidetector CT findings, complications, and differential diagnosis | Insights into Imaging | Full Text
https://insightsimaging.springeropen.com/articles/10.1007/s13244-017-0562-5
Mortality increases with age and comorbidities, and is higher in patients without previous history of PUD. […] Bleeding is nowadays the most common PUD complication, which affects up to 15% of patients (incidence 1957 cases/100.000 individuals/year) with NSAID use as key risk factor. […] Despite effective treatment, PUD-related haemorrhage tends to recur and up to 31% of patients will experience rebleeding within a month. […] Gastric outlet obstruction (GOO) refers to blocked passage of gastric contents into the duodenum from a partial or complete obstacle located at the distal stomach, pylorus, or duodenal bulb. […] Currently, obstruction represents an uncommon PUD complication with a 2% incidence, in 80% of cases secondary to scarring from prolonged inflammation in untreated or long-standing bulbar ulcers. […] Contrary to intraperitoneal perforation, which causes free peritonitis in the abdominal cavity, posterior duodenal ulcers may occasionally penetrate into the retroperitoneum or fistulise to adjacent organs such as the pancreas, common bile duct, gallbladder or liver.
#2 Epidemiology of perforating peptic ulcer: A population-based retrospective study over 40 years
https://www.wjgnet.com/1007-9327/full/v26/i35/5302.htm
Epidemiology of perforating peptic ulcer: A population-based retrospective study over 40 years. The incidence of peptic ulcer disease has decreased during the last few decades, but the incidence of reported peptic ulcer complications has not decreased. Perforating peptic ulcer (PPU) is a severe form of the disease. To assess trends in the incidence, presentation, and outcome of PPU over a period of 40 years. This was a single-centre, retrospective, cohort study of all patients admitted to Levanger Hospital, Norway, with PPU from 1978 to 2017. The incidence of PPU was analysed using Poisson regression with perforated ulcer as the dependent variable, and sex, age, and calendar year from 1978 to 2017 as covariates. Declining incidence rates occurred in recent years, but the patients were older and had more comorbidity. The ASA score was associated with both short-term mortality and long-term survival. The incidence of peptic ulcer disease (PUD) has decreased during the last few decades. However, the incidence of peptic ulcer complications has not decreased in the same manner. The incidence of PPU was defined as the number of new cases of PPU in the defined population within 1 year. The incidence rate (IR) was defined as the incidence divided by the total person-time at risk during the same year. The IR increased significantly with age for both gastric and duodenal PPUs. The IR tended to decline during the last half of the observation period, and this tendency occurred almost one decade earlier for men than women. The patients admitted with PPU had increasing comorbidity in recent decades according to the Charlson Comorbidity Index and ASA class. Increasing age and greater comorbidity in the patients treated for PPU could explain the increase in serious complications. The short-term mortality was associated with ASA score, supporting the understanding that patient comorbidity affects mortality.
#2 Quality of care of peptic ulcer disease worldwide: A systematic analysis for the global burden of disease study 1990â2019 | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0271284
Peptic ulcer disease (PUD) affects four million people worldwide annually and has an estimated lifetime prevalence of 510% in the general population. […] Worldwide, there are significant heterogeneities in coping approaches of healthcare systems with PUD in prevention, diagnosis, treatment, and follow-up. […] Quantifying and benchmarking health systems performance is crucial yet challenging to provide a clearer picture of the potential global inequities in the quality of care. […] The objective of this study was to compare the health-system quality-of-care and inequities for PUD among age groups and sexes worldwide. […] Global QCI was 72.6 in 1990, which increased by 14.6% to 83.2 in 2019. […] QCI of PUD improved dramatically during 19902019 worldwide. There are still significant heterogeneities among countries on different and similar SDI levels.
#2 Quality of care of peptic ulcer disease worldwide: A systematic analysis for the global burden of disease study 1990â2019
https://pmc.ncbi.nlm.nih.gov/articles/PMC9342757/
Peptic ulcer disease (PUD) affects four million people worldwide annually and has an estimated lifetime prevalence of 5-10% in the general population. […] Worldwide, there are significant heterogeneities in coping approaches of healthcare systems with PUD in prevention, diagnosis, treatment, and follow-up. […] Quantifying and benchmarking health systems performance is crucial yet challenging to provide a clearer picture of the potential global inequities in the quality of care. […] The objective of this study was to compare the health-system quality-of-care and inequities for PUD among age groups and sexes worldwide. […] Global QCI was 72.6 in 1990, which increased by 14.6% to 83.2 in 2019. […] QCI of PUD improved dramatically during 1990-2019 worldwide. […] There are still significant heterogeneities among countries on different and similar SDI levels.
#2 Epidemiology of peptic ulcer disease | SpringerLink
https://link.springer.com/chapter/10.1007/978-94-009-1245-8_1
The epidemiology of both gastric and duodenal ulcer is characterized by marked geographic and temporal variations. The incidence, prevalence and mortality of gastric and duodenal ulcer vary four- to ten-fold among different European countries. […] During the past 2030 years the number of patients who died from peptic ulcer disease, who have been operated upon, who saw physicians or were hospitalized for peptic ulcer disease have decreased by more than 100 per cent. These changes occurred within so short a period that a genetic basis can be ruled out. Thus, it seems likely that they stem from changes in environmental risk factors. The geographic variability of ulcer prevalence among populations of similar ethnicity and comparable medical standards also hints at environmental influences. Judging from their effect, it appears that environmental factors are of sufficient magnitude to constitute a fertile ground for inquiry because such information would engender the development of potent measures for prevention and treatment of gastric and duodenal ulcer disease. In addition, knowledge of environmental risk factors could provide new insights and methods to study the pathophysiology of peptic ulcer.