Wrzód żołądka – Epidemiologia

Wrzód żołądka
Epidemiologia

Wrzód żołądka stanowi około jedną trzecią wszystkich wrzodów trawiennych, z roczną zachorowalnością na poziomie 0,1-0,3% (1 przypadek na 1000 osobolat). Epidemiologia choroby wykazuje znaczne zróżnicowanie geograficzne i demograficzne, z wyższą częstością w krajach o większym rozpowszechnieniu zakażenia Helicobacter pylori (do 70% populacji w krajach rozwijających się). Występowanie wrzodów żołądka wzrasta z wiekiem, osiągając szczyt w 5-7 dekadzie życia, a czynniki ryzyka obejmują zakażenie H. pylori (obecne u około 70% pacjentów z wrzodami żołądka), przewlekłe stosowanie NLPZ (zwiększające ryzyko 3-4-krotnie), palenie tytoniu (RR 2,0) oraz czynniki socjoekonomiczne i genetyczne. Powikłania choroby to przede wszystkim krwawienie (dotyczące do 15% pacjentów, z zachorowalnością 1957/100 000 osób/rok), perforacja (0,19-3% przypadków, śmiertelność do 30%) oraz niedrożność odźwiernika (2%). Śmiertelność z powodu choroby wrzodowej wynosi około 1 na 100 000 osób rocznie, a 30-dniowa śmiertelność po perforacji sięga 16,3%.

Epidemiologia wrzodu żołądka

Rozpowszechnienie geograficzne
Trendy czasowe
Różnice wiekowe i płciowe

Czynniki ryzyka i etiologia
Komplikacje i śmiertelność

Krwawienie
Perforacja
Niedrożność odźwiernika
Śmiertelność

Nadzór i monitorowanie

Endoskopia kontrolna
Testowanie na H. pylori

Trendy i prognozy

Obciążenie ekonomiczne
Świadomość publiczna
Zmiana paradygmatu w zrozumieniu choroby wrzodowej
Kolejne rozdziały

Epidemiologia wrzodu żołądka

Wrzód żołądka stanowi istotną część choroby wrzodowej, która dotyka około 5-10% populacji w ciągu życia, przy czym roczna zachorowalność wynosi około 0,1-0,3% (1 przypadek na 1000 osobolat)¹²³. Wrzody żołądka stanowią około jedną trzecią wszystkich wrzodów trawiennych, podczas gdy wrzody dwunastnicy odpowiadają za pozostałe dwie trzecie⁴. Epidemiologia wrzodów żołądka charakteryzuje się znacznymi różnicami geograficznymi i czasowymi, z czterokrotną do dziesięciokrotnej zmiennością występowania między różnymi krajami europejskimi⁵.

Rozpowszechnienie geograficzne

Częstość występowania choroby wrzodowej żołądka różni się w zależności od występowania zakażenia Helicobacter pylori. Wyższe wskaźniki występują w krajach, gdzie zakażenie H. pylori jest bardziej rozpowszechnione⁶. W krajach rozwiniętych odsetek osób z zakażeniem H. pylori wynosi maksymalnie 40%, podczas gdy w krajach rozwijających się szacuje się, że sięga on 70% populacji⁷. W Stanach Zjednoczonych występowanie H. pylori rośnie wraz z wiekiem – od 16,7% w młodszych grupach wiekowych (20-29 lat) do 56,9% w starszych grupach (powyżej 70 lat)⁸.

Systematyczny przegląd literatury z krajów rozwiniętych wykazał, że globalna częstość występowania choroby wrzodowej zdiagnozowanej przez lekarzy wynosiła 0,12-1,50%, a częstość występowania na podstawie danych hospitalizacyjnych wynosiła 0,10-0,19%⁹. W 2018 roku systematyczny przegląd badań z baz MEDLINE i PubMed wykazał, że Hiszpania miała najwyższą roczną zachorowalność na wszystkie choroby wrzodowe (141,8/100 000 osób), podczas gdy Wielka Brytania miała najniższą (23,9/100 000 osób)¹⁰.

Trendy czasowe

Ogólnie obserwuje się spadek częstości występowania choroby wrzodowej na całym świecie, co jest związane z poprawą warunków higienicznych i sanitarnych, w połączeniu z efektywnym leczeniem i rozważnym stosowaniem niesteroidowych leków przeciwzapalnych (NLPZ)¹¹. Jednakże dane z 2019 roku wskazują, że globalna częstość występowania choroby wrzodowej wynosiła około 8,09 miliona przypadków, co stanowi wzrost o 25,82% od 1990 roku, chociaż standaryzowany względem wieku wskaźnik częstości występowania wynosił 99,40 na 100 000 populacji, co oznacza spadek o 143,37 na 100 000 populacji od 1990 roku¹².

Zmniejszenie liczby przypadków choroby wrzodowej po wprowadzeniu terapii eradykacyjnej H. pylori jest uważane za czynnik przyczyniający się do zmniejszenia zachorowalności na raka żołądka. W Japonii badania wykazały, że leczenie eradykacyjne H. pylori wyjaśniało około 84% dramatycznego spadku liczby przypadków choroby wrzodowej¹³.

Różnice wiekowe i płciowe

Częstość występowania wrzodów żołądka zwiększa się wraz z wiekiem, z największą zachorowalnością w 5-7 dekadzie życia¹⁴. Standaryzowane względem wieku wskaźniki częstości występowania wzrastają wraz z wiekiem, osiągając szczyt w wieku 80-84 lat zarówno u mężczyzn, jak i kobiet, a następnie spadają aż do osiągnięcia najstarszej grupy wiekowej¹⁵.

W przeciwieństwie do wrzodów dwunastnicy, które są około czterokrotnie częstsze u mężczyzn niż u kobiet, w przypadku wrzodów żołądka nie obserwuje się różnicy w częstości występowania między mężczyznami a kobietami¹⁶. Jednakże niektóre źródła wskazują, że wrzody żołądka są około dwukrotnie częstsze u mężczyzn niż u kobiet¹⁷.

Globalne występowanie choroby wrzodowej było wyższe u kobiet niż u mężczyzn na obu końcach spektrum wiekowego (powyżej 70 lat i poniżej 24 lat)¹⁸. Ogólnie, częstość występowania choroby wrzodowej zmieniła się z dominacji u mężczyzn do podobnego występowania u obu płci, z szacowaną częstością występowania w ciągu życia wynoszącą około 11-14% u mężczyzn i 8-11% u kobiet¹⁹.

Czynniki ryzyka i etiologia

Główne czynniki ryzyka rozwoju wrzodów żołądka to zakażenie Helicobacter pylori i stosowanie niesteroidowych leków przeciwzapalnych (NLPZ). Zakażenie H. pylori można stwierdzić u około 70% pacjentów z wrzodami żołądka, w porównaniu do ponad 95% pacjentów z wrzodami dwunastnicy²⁰.

Stosowanie NLPZ wiąże się z trzy- do czterokrotnym wzrostem ryzyka wystąpienia wrzodu żołądka²¹. Szacuje się, że u 25% osób przewlekle stosujących NLPZ rozwinie się wrzód żołądka²².

Badania wykazały, że palenie tytoniu prowadzi do względnego ryzyka 2,0 razy większego niż u osób niepalących w rozwoju wrzodów żołądka²³. Inne czynniki ryzyka obejmują wiek, przewlekłe stosowanie NLPZ, występowanie wrzodu żołądka u krewnych pierwszego stopnia oraz niski poziom wykształcenia²⁴.

Występowanie wrzodów żołądka było historycznie częstsze w niższych grupach społeczno-ekonomicznych, choć trend ten wydaje się zmieniać²⁵. Częściej występują również u pacjentów z grupą krwi A²⁶.

Komplikacje i śmiertelność

Choroba wrzodowa żołądka może prowadzić do poważnych powikłań, które wiążą się ze znaczną zachorowalnością i śmiertelnością. Obecnie krwawienie z przewodu pokarmowego jest zdecydowanie najczęstszym powikłaniem, a następnie perforacja, niedrożność odźwiernika i tworzenie przetok, w kolejności malejącej częstości²⁷.

Krwawienie

Krwawienie jest obecnie najczęstszym powikłaniem choroby wrzodowej, które dotyka do 15% pacjentów (zachorowalność 1957 przypadków/100 000 osób/rok), przy czym stosowanie NLPZ jest kluczowym czynnikiem ryzyka²⁸. Przewlekłe krwawienie z wrzodu żołądka może prowadzić do anemii²⁹.

Perforacja

Chociaż globalna częstość występowania perforacji wrzodu trawiennego jest stosunkowo niska, wynosząc 0,19-3%, jej śmiertelność i zachorowalność jest wysoka, odpowiednio do 30% i 50%³⁰. W populacyjnym badaniu retrospektywnym przeprowadzonym w Norwegii wskaźnik zachorowalności na perforowany wrzód trawienny w okresie 10 lat wynosił 6,5 na 100 000 osób rocznie, a wskaźnik śmiertelności wynosił 1,1 na 100 000 osób rocznie³¹.

Niedrożność odźwiernika

Niedrożność odźwiernika odnosi się do zablokowania przejścia treści żołądkowej do dwunastnicy z powodu częściowej lub całkowitej przeszkody zlokalizowanej w dystalnej części żołądka, odźwierniku lub opuszce dwunastnicy. Obecnie niedrożność stanowi niezbyt częste powikłanie choroby wrzodowej z częstością występowania 2%, w 80% przypadków wtórne do bliznowacenia w wyniku długotrwałego zapalenia w nieleczonych lub długotrwałych wrzodach opuszki³².

Śmiertelność

Wskaźnik śmiertelności z powodu choroby wrzodowej wynosi około 1 na 100 000 osób³³. Choroba wrzodowa była przyczyną 301 000 zgonów w 2013 roku, w porównaniu do 327 000 w 1990 roku³⁴. W Stanach Zjednoczonych choroba wrzodowa jest główną zgłaszaną przyczyną śmierci u około 6500 osób rocznie³⁵.

Śmiertelność zwiększa się wraz z wiekiem i chorobami współistniejącymi oraz jest wyższa u pacjentów bez wcześniejszej historii choroby wrzodowej³⁶. Ogólna 30-dniowa śmiertelność w przypadku perforowanego wrzodu trawiennego wynosiła 16,3% w badaniu norweskim³⁷.

Nadzór i monitorowanie

Nadzór nad chorobą wrzodową żołądka jest istotnym elementem zarządzania tą chorobą, szczególnie w kontekście wykrywania potencjalnego nowotworu złośliwego. Po zdiagnozowaniu wrzodu żołądka rutynową praktyką stało się wykonanie powtórnej endoskopii kilka tygodni później, aby zapewnić gojenie się wrzodu i wykluczyć złośliwość³⁸.

Endoskopia kontrolna

Amerykańskie Towarzystwo Endoskopii Przewodu Pokarmowego (ASGE) opublikowało wytyczne dotyczące endoskopii u pacjentów z bólem w górnej części brzucha lub objawami dyspeptycznymi sugerującymi chorobę wrzodową. ASGE sugeruje, aby decyzja o przeprowadzeniu endoskopii kontrolnej u pacjentów z wrzodem żołądka była indywidualizowana. Endoskopia kontrolna jest zalecana dla pacjentów z wrzodem żołądka, którzy pozostają objawowi pomimo odpowiedniego kursu terapii medycznej³⁹.

Wykrywanie wielu wrzodów żołądka różni się w zależności od techniki obrazowania: badania z pojedynczym kontrastem – 2-8%; badania z podwójnym kontrastem – około 20%; i endoskopia – nawet 30%. Wiele wrzodów jest częstszych u pacjentów stosujących aspirynę lub niesteroidowe leki przeciwzapalne (NLPZ)⁴⁰.

Testowanie na H. pylori

Obecnie zaleca się testowanie na obecność Helicobacter pylori u wszystkich pacjentów z chorobą wrzodową⁴¹. Obecność H. pylori można potwierdzić za pomocą biopsji uzyskanych podczas endoskopii i testu oddechowego z mocznikiem, których kombinacja daje wskaźnik wykrywalności bliski 100%⁴².

W 1994 roku panel konferencji rozwoju konsensusu Narodowych Instytutów Zdrowia doszedł do wniosku, że pacjenci z wrzodami spowodowanymi zakażeniem H. pylori wymagają leczenia środkami przeciwdrobnoustrojowymi⁴³. Chociaż skuteczne strategie profilaktyki pierwotnej pozostają do zdefiniowania, odpowiednia diagnoza i leczenie antybiotykami mogą znacznie zmniejszyć obciążenie chorobą wrzodową⁴⁴.

Trendy i prognozy

Zachorowalność i śmiertelność z powodu choroby wrzodowej znacznie spadły w latach 1990-2019, chociaż w ostatnich 15 latach zaobserwowano stopniowy wzrost, co może być związane ze zmianami czynników ryzyka choroby wrzodowej⁴⁵.

W ciągu ostatnich 20-30 lat zachorowalność na chorobę wrzodową spadła, szczególnie w krajach o wysokich dochodach, ze względu na zwiększenie liczby placówek szpitalnych i wprowadzenie nowych i skutecznych terapii⁴⁶. Jednak częstość występowania powikłanej choroby wrzodowej żołądka i hospitalizacji pozostała stabilna, częściowo z powodu jednoczesnego stosowania aspiryny w starzejącej się populacji⁴⁷.

Rokowanie w chorobie wrzodowej żołądka jest doskonałe po skutecznym leczeniu przyczyny podstawowej. Nawrót wrzodu można zapobiec, utrzymując dobrą higienę i unikając alkoholu, palenia tytoniu i NLPZ. Niestety, nawroty są częste, z wskaźnikami przekraczającymi 60% w większości serii⁴⁸.

Obciążenie ekonomiczne

Choroba wrzodowa żołądka stanowi znaczne obciążenie ekonomiczne. Szacowane bezpośrednie koszty opieki nad pacjentem i pośrednie koszty spowodowane utratą pracy i produktywności z powodu choroby wrzodowej wynoszą 6 miliardów dolarów rocznie w Stanach Zjednoczonych⁴⁹. W innym źródle szacuje się, że koszty te wynoszą około 3,3 miliarda dolarów rocznie⁵⁰.

Świadomość publiczna

Pomimo znacznego postępu w zrozumieniu patogenezy choroby wrzodowej, świadomość publiczna na temat związku między zakażeniem H. pylori a chorobą wrzodową pozostaje ograniczona. Badania wykazały, że tylko 27% ogółu społeczeństwa jest świadomych związku między zakażeniem H. pylori a chorobą wrzodową⁵¹.

Centrum Kontroli i Zapobiegania Chorobom (CDC), we współpracy z organizacjami partnerskimi, opracowało krajową kampanię mającą na celu zwiększenie świadomości i edukację ogółu społeczeństwa i środowiska medycznego na temat związku między zakażeniem H. pylori a chorobą wrzodową⁵².

Zmiana paradygmatu w zrozumieniu choroby wrzodowej

Uderzającym przykładem zmiany paradygmatu w medycynie jest zmiana w naszym zrozumieniu wrzodów żołądka. Przez lata wrzody były przypisywane stresowi i pikantnym potrawom, ale to się zmieniło, gdy australijski gastroenterolog i badacz Barry Marshall w odważnym ruchu połknął Helicobacter pylori, aby zademonstrować jego potencjalną rolę w rozwoju choroby wrzodowej⁵³.

Jak pokazuje ten przykład, gdy przedstawiono dowody, klinicyści i naukowcy przyznali, że się mylili co do przyczyny wrzodów żołądka. Praktyka kliniczna uległa następnie poprawie, a lekarze zaczęli przepisywać antybiotyki w celu zabicia bakterii powodujących wrzody⁵⁴.

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Materiały źródłowe

#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).
#2 Pulsenotes | Peptic ulcer disease notes
https://app.pulsenotes.com/medicine/gastroenterology/notes/peptic-ulcer-disease
There is an estimated lifetime prevalence of 5-10%. […] The annual incidence is thought to be around 0.1-0.3%. The epidemiological pattern varies based on the affected location: […] Gastric ulcers: Incidence increases with age with equal gender distribution. […] Duodenal ulcers: Appear to be more common in men with incidence that peaks between the ages of 45-64.
#3 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%)
#4 Gastric Ulcer Imaging: Practice Essentials, Radiography, Computed Tomography
https://emedicine.medscape.com/article/368602-overview
Peptic ulcers are mucosal breaks of 3 mm or greater and are common, occurring in about 10% of adults in Western countries. Gastric ulcers account for about one third of peptic ulcers, and duodenal ulcers account for the remainder. […] The American Society of Gastrointestinal Endoscopy (ASGE) has published guidelines regarding endoscopy in patients with upper abdominal pain or dyspeptic symptoms that suggest peptic ulcer disease. The ASGE suggests that the decision to perform surveillance endoscopy in patients with a gastric ulcer be individualized. Surveillance endoscopy is suggested for patients with gastric ulcer who remain symptomatic despite an appropriate course of medical therapy. […] Detection of multiple gastric ulcers varies with the imaging technique: single-contrast studies, 2-8%; double-contrast studies, about 20%; and endoscopy, as high as 30%. Multiple ulcers are more common in patients using aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs).
#5 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.
#6 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. […] 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.
#7 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).
#8 Peptic Ulcer Disease | IntechOpen
https://www.intechopen.com/chapters/67428
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 the United States, the seroprevalence of H. pylori infection varies with age: 16.7% in young age (20-29 years) group and 56.9% in older age (70 years) group. It is also different among different ethnicities: non-Hispanic whites 26.2%, non-Hispanic blacks 52.7%, and Mexican Americans 61.6%. […] 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 0.10-0.19% and 0.12-1.50%, 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.
#9 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.
#10 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).
#11 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. […] Today, testing for Helicobacter pylori is recommended in all patients with peptic ulcer disease. Endoscopy may be required in some patients to confirm the diagnosis, especially in those patients with sinister symptoms. […] The prognosis of peptic ulcer disease (PUD) is excellent after the underlying cause is successfully treated. Recurrence of the ulcer may be prevented by maintaining good hygiene and avoiding alcohol, smoking, and NSAIDs. Unfortunately, recurrence is common with rates exceeding 60% in most series.
#12 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. The age-standardized DALY rate in 2019 was decreased by 60.64% compared to that in 1990.
#13 Dramatic shift in the epidemiology of peptic ulcer in Japan: the impact of Helicobacter pylori eradication therapy | Epidemiology & Infection | Cambridge Core
https://www.cambridge.org/core/journals/epidemiology-and-infection/article/dramatic-shift-in-the-epidemiology-of-peptic-ulcer-in-japan-the-impact-of-helicobacter-pylori-eradication-therapy/461799878433B311D9CC411BA37DA23F
The present study describes the snapshot case number of peptic ulcer using parsimonious statistical models that highlighted the prevalence of H. pylori infection, as well as its eradication therapy and other important events that are presumably associated with the pathophysiological development of peptic ulcer. […] As an important take-home message, H. pylori and its eradication therapy in combination contributed approximately 84% of the time series of peptic ulcer cases. […] The remarkable reduction of peptic ulcer cases after the introduction of eradication therapy is believed to have reduced gastric cancer incidence. […] Overall, there has been a dramatic decline in the snapshot number of peptic ulcer cases in Japan, and H. pylori infection and eradication therapy explained approximately 84% of this phenomenon.
#14 Peptic Ulcer Disease: Causes and Treatment | Doctor
https://patient.info/doctor/peptic-ulcer-disease
Dyspepsia occurs in 40% of the population annually and leads to a primary care consultation in 5% and endoscopy in 1%. […] The lifetime prevalence of peptic ulcer disease in the general population is estimated to be approximately 5-10%. The incidence of peptic ulcer disease is about 0.1-0.3% per year. The incidence of gastric ulcers peaks in the 5th to 7th decades. The incidence of duodenal ulcers peaks in the 3rd to 5th decades. […] Peptic ulcer disease prevalence is decreasing in the West, but there is ethnic variation. One systematic review reported that globally, the annual incidence rates of peptic ulcer disease were 0.10-0.19% for physician-diagnosed disease and 0.03-0.17% when based on hospitalisation data. Overall, incidence and prevalence were decreasing, thought to be due to a decrease in H. pylori-related peptic ulcer disease.
#15 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
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. […] In this study, we analyzed PUD burdens in 204 countries or territories from 1990 to 2019 based on data from the Global Burden of Disease, Injuries and Risk Factors (GBD) Study, which is updated in 2020 and contains epidemiological and socioeconomic data of 354 diseases globally, allowing evaluations of the burdens, distributions and trends of PUD in different regions. […] The global prevalence of PUD was higher in females than in males on both ends of the age spectrum (more than 70 and less than 24 years old). […] The age-standardized prevalence rates increased with age, peaking at 80-84 years in both males and females and then decreased until patients reached the oldest age group in 2019.
#16 Gastric Ulcer – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK537128/
Gastric ulcers are a part of peptic ulcer disease, which carries a lifetime prevalence of 5 to 10% of patients, which is likely an underestimation of the disease as some patients may remain asymptomatic. […] Studies have shown that the prevalence of gastric ulcers increases with age and with the chronicity of NSAID use. […] Research shows that smoking leads to a relative risk of 2.0 times that of non-smokers for developing gastric ulcers. […] There is no difference between men and women in the prevalence of gastric ulcers. […] The prevalence of Helicobacter pylori infection at age 60 approximates 50% in the US population. […] Estimates are that 25% of chronic NSAID users will develop gastric ulcers.
#17 Epidemiology of gastric ulcer â GPnotebook
https://gpnotebook.com/pages/nutrition/gastric-ulcer/epidemiology-of-gastric-ulcer
common condition in late middle age – incidence increases with age […] approximately twice as common in males than in females […] more common in patients with blood group A […] was more common in lower socio-economic groups – this seems to be changing […] use of NSAIDs – associated with a three- to four-fold increase in risk of gastric ulcer […] less related to Helicobacter pylori than duodenal ulcers – H. pylori can be isolated from 70% of patients with gastric ulcers compared to over 95% of patients with duodenal ulcers
#18 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
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. […] In this study, we analyzed PUD burdens in 204 countries or territories from 1990 to 2019 based on data from the Global Burden of Disease, Injuries and Risk Factors (GBD) Study, which is updated in 2020 and contains epidemiological and socioeconomic data of 354 diseases globally, allowing evaluations of the burdens, distributions and trends of PUD in different regions. […] The global prevalence of PUD was higher in females than in males on both ends of the age spectrum (more than 70 and less than 24 years old). […] The age-standardized prevalence rates increased with age, peaking at 80-84 years in both males and females and then decreased until patients reached the oldest age group in 2019.
#19 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.
#20 Epidemiology of gastric ulcer â GPnotebook
https://gpnotebook.com/pages/nutrition/gastric-ulcer/epidemiology-of-gastric-ulcer
common condition in late middle age – incidence increases with age […] approximately twice as common in males than in females […] more common in patients with blood group A […] was more common in lower socio-economic groups – this seems to be changing […] use of NSAIDs – associated with a three- to four-fold increase in risk of gastric ulcer […] less related to Helicobacter pylori than duodenal ulcers – H. pylori can be isolated from 70% of patients with gastric ulcers compared to over 95% of patients with duodenal ulcers
#21 Epidemiology of gastric ulcer â GPnotebook
https://gpnotebook.com/pages/nutrition/gastric-ulcer/epidemiology-of-gastric-ulcer
common condition in late middle age – incidence increases with age […] approximately twice as common in males than in females […] more common in patients with blood group A […] was more common in lower socio-economic groups – this seems to be changing […] use of NSAIDs – associated with a three- to four-fold increase in risk of gastric ulcer […] less related to Helicobacter pylori than duodenal ulcers – H. pylori can be isolated from 70% of patients with gastric ulcers compared to over 95% of patients with duodenal ulcers
#22 Gastric Ulcer – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK537128/
Gastric ulcers are a part of peptic ulcer disease, which carries a lifetime prevalence of 5 to 10% of patients, which is likely an underestimation of the disease as some patients may remain asymptomatic. […] Studies have shown that the prevalence of gastric ulcers increases with age and with the chronicity of NSAID use. […] Research shows that smoking leads to a relative risk of 2.0 times that of non-smokers for developing gastric ulcers. […] There is no difference between men and women in the prevalence of gastric ulcers. […] The prevalence of Helicobacter pylori infection at age 60 approximates 50% in the US population. […] Estimates are that 25% of chronic NSAID users will develop gastric ulcers.
#23 Gastric Ulcer – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK537128/
Gastric ulcers are a part of peptic ulcer disease, which carries a lifetime prevalence of 5 to 10% of patients, which is likely an underestimation of the disease as some patients may remain asymptomatic. […] Studies have shown that the prevalence of gastric ulcers increases with age and with the chronicity of NSAID use. […] Research shows that smoking leads to a relative risk of 2.0 times that of non-smokers for developing gastric ulcers. […] There is no difference between men and women in the prevalence of gastric ulcers. […] The prevalence of Helicobacter pylori infection at age 60 approximates 50% in the US population. […] Estimates are that 25% of chronic NSAID users will develop gastric ulcers.
#24 Aetiology of peptic ulcer: a prospective population study in Norway. | Journal of Epidemiology & Community Health
https://jech.bmj.com/content/48/2/156
STUDY OBJECTIVE–To analyse simultaneously the effect of several risk factors for peptic ulcer. […] A total of 328 people had their first peptic ulcer in the follow up period. Age, cigarette smoking, first degree relatives with peptic ulcer, and low educational level were shared risk factors for peptic ulcer in both men and women. […] Age, inheritance, and cigarette smoking are all important risk factors for peptic ulcer. The increased risk associated with low educational background indicate that social strains, comprising lifestyle and diet habits, are part of the multifactorial aetiology of peptic ulcer. […] This study did not support the view that duodenal and gastric ulcers have different aetiologies-rather it showed a similarity in risk patterns.
#25 Epidemiology of gastric ulcer â GPnotebook
https://gpnotebook.com/pages/nutrition/gastric-ulcer/epidemiology-of-gastric-ulcer
common condition in late middle age – incidence increases with age […] approximately twice as common in males than in females […] more common in patients with blood group A […] was more common in lower socio-economic groups – this seems to be changing […] use of NSAIDs – associated with a three- to four-fold increase in risk of gastric ulcer […] less related to Helicobacter pylori than duodenal ulcers – H. pylori can be isolated from 70% of patients with gastric ulcers compared to over 95% of patients with duodenal ulcers
#26 Epidemiology of gastric ulcer â GPnotebook
https://gpnotebook.com/pages/nutrition/gastric-ulcer/epidemiology-of-gastric-ulcer
common condition in late middle age – incidence increases with age […] approximately twice as common in males than in females […] more common in patients with blood group A […] was more common in lower socio-economic groups – this seems to be changing […] use of NSAIDs – associated with a three- to four-fold increase in risk of gastric ulcer […] less related to Helicobacter pylori than duodenal ulcers – H. pylori can be isolated from 70% of patients with gastric ulcers compared to over 95% of patients with duodenal ulcers
#27 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.
#28 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. […] 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.
#29 Centre for Health Protection – Men’s Health Line – Peptic ulcer
https://www.chp.gov.hk/en/static/80053.html
Peptic ulcer is a common disease among busy city dwellers. […] Infection with a kind of bacteria known as Helicobacter pylori – associated with as many as 90% of duodenal ulcers and 70-75% of gastric ulcers. […] Peptic ulcer with chronic bleeding may cause anaemia. […] The majority of patients with peptic ulcer can be successfully treated with eradication of Helicobacter pylori infection, drugs to reduce the secretion of stomach acid and avoidance of risk factors like NSAID. […] When the causes of peptic ulcer are removed, the chance of recurrence will be greatly reduced.
#30 Factors associated with peptic ulcer perforations in Uganda: a multi-hospital cross-sectional study | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-024-03285-w
Perforated peptic ulcer is the worst complication of peptic ulcer disease whose burden is disproportionately higher in low-income settings. […] Globally, over 4,000,000 individuals are affected by peptic ulcer disease annually, with a life time risk of perforation of 5%. […] Whereas the global incidence of peptic ulcer perforation is reportedly low at 0.19-3%; its resulting mortality and morbidity is high; up to 30% and 50% respectively. […] Higher rates are still seen in Asia and Africa due to the high burden of Helicobacter pylori infection caused by poor hygienic practices. […] The existing studies indicate mixed findings where some scholars document increased prevalence of gastric ulcers in blood group O whereas others report increased prevalence in blood group B. […] Our findings showed that gastric perforations were more common than duodenal perforations.
#31 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. The aim of this study was to investigate the recent epidemiological incidence trends and presentation of benign perforated gastroduodenal peptic ulcer in a well-defined Norwegian population. A total of 172 patients with a perforated peptic ulcer were identified between 2001 and 2010. 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.
#32 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. […] 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.
#33 Peptic ulcer epidemiology and demographics – wikidoc
https://www.wikidoc.org/index.php/Peptic_ulcer_epidemiology_and_demographics
The mortality rate of peptic ulcer disease is approximately 1 per 100,000 individuals. […] Peptic ulcer disease is acquired during childhood. […] The incidence of Peptic ulcer disease increases with age; the median age at diagnosis is 18-30 years. […] Peptic ulcer disease usually affects individuals of the African Americans with a higher proportion of African ancestry race and Mexican Americans. […] Non-Hispanic whites individuals are less likely to develop the peptic ulcer disease. […] Men are more commonly affected by peptic ulcer disease than women in adulthood.
#34 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).
#35
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. 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 development of effective treatment has enabled a new public health approach to PUD, which was previously considered a chronic disease. 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.
#36 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. […] 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.
#37 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. The aim of this study was to investigate the recent epidemiological incidence trends and presentation of benign perforated gastroduodenal peptic ulcer in a well-defined Norwegian population. A total of 172 patients with a perforated peptic ulcer were identified between 2001 and 2010. 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.
#38
https://journals.lww.com/ajg/fulltext/2022/10002/s1609_utility_of_surveillance_endoscopy_for.1609.aspx
After diagnosing a gastric ulcer, it has become routine practice to perform a repeat endoscopy several weeks later to ensure ulcer healing and to rule out malignancy. Current guidelines for surveillance endoscopy (SE) are based on little to no evidence. […] The pre-intervention data establishes a baseline for our QI project and helped us create a more precise algorithm for SE. Most importantly, we have incorporated biopsies for all ulcers at index endoscopy.
#39 Gastric Ulcer Imaging: Practice Essentials, Radiography, Computed Tomography
https://emedicine.medscape.com/article/368602-overview
Peptic ulcers are mucosal breaks of 3 mm or greater and are common, occurring in about 10% of adults in Western countries. Gastric ulcers account for about one third of peptic ulcers, and duodenal ulcers account for the remainder. […] The American Society of Gastrointestinal Endoscopy (ASGE) has published guidelines regarding endoscopy in patients with upper abdominal pain or dyspeptic symptoms that suggest peptic ulcer disease. The ASGE suggests that the decision to perform surveillance endoscopy in patients with a gastric ulcer be individualized. Surveillance endoscopy is suggested for patients with gastric ulcer who remain symptomatic despite an appropriate course of medical therapy. […] Detection of multiple gastric ulcers varies with the imaging technique: single-contrast studies, 2-8%; double-contrast studies, about 20%; and endoscopy, as high as 30%. Multiple ulcers are more common in patients using aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs).
#40 Gastric Ulcer Imaging: Practice Essentials, Radiography, Computed Tomography
https://emedicine.medscape.com/article/368602-overview
Peptic ulcers are mucosal breaks of 3 mm or greater and are common, occurring in about 10% of adults in Western countries. Gastric ulcers account for about one third of peptic ulcers, and duodenal ulcers account for the remainder. […] The American Society of Gastrointestinal Endoscopy (ASGE) has published guidelines regarding endoscopy in patients with upper abdominal pain or dyspeptic symptoms that suggest peptic ulcer disease. The ASGE suggests that the decision to perform surveillance endoscopy in patients with a gastric ulcer be individualized. Surveillance endoscopy is suggested for patients with gastric ulcer who remain symptomatic despite an appropriate course of medical therapy. […] Detection of multiple gastric ulcers varies with the imaging technique: single-contrast studies, 2-8%; double-contrast studies, about 20%; and endoscopy, as high as 30%. Multiple ulcers are more common in patients using aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs).
#41 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. […] Today, testing for Helicobacter pylori is recommended in all patients with peptic ulcer disease. Endoscopy may be required in some patients to confirm the diagnosis, especially in those patients with sinister symptoms. […] The prognosis of peptic ulcer disease (PUD) is excellent after the underlying cause is successfully treated. Recurrence of the ulcer may be prevented by maintaining good hygiene and avoiding alcohol, smoking, and NSAIDs. Unfortunately, recurrence is common with rates exceeding 60% in most series.
#42 Peptic ulcer disease | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/peptic-ulcer-disease?embed_domain=external.radpair.com%27%5B0%5D%27%5B0%5D&lang=us
Generally, peptic ulcer disease is encountered more frequently in males (M:F 3:1) and usually in the older population. […] The majority of cases are due to infection with Helicobacter pylori. This can be confirmed with biopsies obtained at endoscopy and urea breath test, the combination of the two resulting in a detection rate of close to 100%.
#43
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. 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. In 1994, a National Institutes of Health consensus development conference panel concluded that patients with ulcers caused by H. pylori infection require treatment with antimicrobial agents. 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. […] Even though effective primary prevention strategies remain to be defined, appropriate diagnosis and antibiotic treatment can substantially reduce the burden of PUD. This secondary prevention strategy depends on awareness that PUD is caused by a curable infection.
#44
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. 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. In 1994, a National Institutes of Health consensus development conference panel concluded that patients with ulcers caused by H. pylori infection require treatment with antimicrobial agents. 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. […] Even though effective primary prevention strategies remain to be defined, appropriate diagnosis and antibiotic treatment can substantially reduce the burden of PUD. This secondary prevention strategy depends on awareness that PUD is caused by a curable infection.
#45 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
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. […] In this study, we analyzed PUD burdens in 204 countries or territories from 1990 to 2019 based on data from the Global Burden of Disease, Injuries and Risk Factors (GBD) Study, which is updated in 2020 and contains epidemiological and socioeconomic data of 354 diseases globally, allowing evaluations of the burdens, distributions and trends of PUD in different regions. […] The global prevalence of PUD was higher in females than in males on both ends of the age spectrum (more than 70 and less than 24 years old). […] The age-standardized prevalence rates increased with age, peaking at 80-84 years in both males and females and then decreased until patients reached the oldest age group in 2019.
#46 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
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 is a common condition, early diagnosis, and treatment, will not only treat your patient, rather, but it will also prevent serious and life-threatening complications.
#47 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.
#48 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. […] Today, testing for Helicobacter pylori is recommended in all patients with peptic ulcer disease. Endoscopy may be required in some patients to confirm the diagnosis, especially in those patients with sinister symptoms. […] The prognosis of peptic ulcer disease (PUD) is excellent after the underlying cause is successfully treated. Recurrence of the ulcer may be prevented by maintaining good hygiene and avoiding alcohol, smoking, and NSAIDs. Unfortunately, recurrence is common with rates exceeding 60% in most series.
#49
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. 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 development of effective treatment has enabled a new public health approach to PUD, which was previously considered a chronic disease. 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.
#50 Peptic Ulcer Disease | IntechOpen
https://www.intechopen.com/chapters/67428
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 the United States, the seroprevalence of H. pylori infection varies with age: 16.7% in young age (20-29 years) group and 56.9% in older age (70 years) group. It is also different among different ethnicities: non-Hispanic whites 26.2%, non-Hispanic blacks 52.7%, and Mexican Americans 61.6%. […] 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 0.10-0.19% and 0.12-1.50%, 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.
#51
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. 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 development of effective treatment has enabled a new public health approach to PUD, which was previously considered a chronic disease. 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.
#52
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. 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 development of effective treatment has enabled a new public health approach to PUD, which was previously considered a chronic disease. 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.
#53 When it comes to health information, who should you trust? 4 ways to spot a dodgy âexpertâverifiedverifiedverifiedverifiedverifiedverifiedverifiedverifiedverifiedverified
https://www.gavi.org/vaccineswork/when-it-comes-health-information-who-should-you-trust-4-ways-spot-dodgy-expert
A striking example of this is the shift in our understanding of stomach ulcers. For years, ulcers were blamed on stress and spicy food, but that changed when Australian gastroenterologist and researcher Barry Marshall, in a bold move, swallowed Helicobacter pylori to demonstrate its potential role. […] As this example highlights, when presented with the evidence, clinicians and scientists acknowledged theyâd got the underlying cause of stomach ulcers wrong. Clinical practice subsequently improved, with doctors prescribing antibiotics to kill the ulcer-causing bacteria.
#54 When it comes to health information, who should you trust? 4 ways to spot a dodgy âexpertâverifiedverifiedverifiedverifiedverifiedverifiedverifiedverifiedverifiedverified
https://www.gavi.org/vaccineswork/when-it-comes-health-information-who-should-you-trust-4-ways-spot-dodgy-expert
A striking example of this is the shift in our understanding of stomach ulcers. For years, ulcers were blamed on stress and spicy food, but that changed when Australian gastroenterologist and researcher Barry Marshall, in a bold move, swallowed Helicobacter pylori to demonstrate its potential role. […] As this example highlights, when presented with the evidence, clinicians and scientists acknowledged theyâd got the underlying cause of stomach ulcers wrong. Clinical practice subsequently improved, with doctors prescribing antibiotics to kill the ulcer-causing bacteria.