Ulcer Diagnosis in a Population With High Prevalence of H pylori
Ulcer Diagnosis in a Population With High Prevalence of H pylori
Background: It is unknown whether the incidence of peptic ulcer changes in areas with a high prevalence of Helicobacter pylori infection.
Aim: To determine trends in peptic ulcer complications in a community with a high prevalence of H. pylori infection.
Methods: New endoscopic diagnoses of peptic ulcers and their complications from 1985 to 2000 were obtained. H. pylori infection in the adult population, the number of prescriptions for anti-secretory drugs and non-steroidal anti-inflammatory drugs were also evaluated.
Results: Although the global prevalence of H. pylori infection remains high in this population (>60%), a 41.4 to 25.4% decrease in the incidence of peptic ulcers and ulcer complications was observed. This was associated with a decrease in the prevalence of H. pylori infection in people under 65 years of age, a 3.5-fold increase in the number of prescriptions of proton-pump inhibitors and an increase in the number of prescriptions of non-steroidal anti-inflammatory drugs, especially coxibs.
Conclusions: In an area with a high prevalence of H. pylori infection, the incidence of peptic ulcer and associated complications is declining rapidly. This was associated with a reduction of the prevalence of H. pylori infection in the young and a widespread use of proton-pump inhibitors. The increase in the use of non-steroidal anti-inflammatory drugs, especially coxibs, has not changed the tendency.
Over the last few years a decrease in the prevalence of uncomplicated gastroduodenal peptic ulcer expressed as a decline in hospital admission rates and mortality from peptic ulcer has been reported. In contrast to these general trends, some studies have shown an increase in the mortality rates from duodenal ulcers and in the admissions for perforated peptic ulcers in western countries especially among the elderly.
The decrease in the trends of non-complicated ulcers had been attributed to a reduced prevalence of Helicobacter pylori infection because of an improvement in the socio-sanitary conditions and the antibiotic treatments to eradicate H. pylori . However, there are no data regarding trends in peptic ulcer disease in countries with a high prevalence of H. pylori . Furthermore, there are a number of potential factors, in addition to the prevalence of H. pylori infection that may affect the incidence of peptic ulcer diagnosis and that have not been properly studied or evaluated in this setting. Some of these factors are of paramount importance, as they may either increase or decrease the incidence of peptic ulcer diseases and complications. In this way, antisecretory drugs are now widely prescribed, but the potential relationship to the incidence of ulcer diagnosis has not been evaluated. On the contrary, a progressive increase in the elderly population of many western countries is associated with a parallel increase in the prescription of ulcerogenic drugs such as non-steroidal anti-inflammatory drugs (NSAIDs). More recently, safer NSAIDs (selective COX-2 inhibitors) have been introduced in the market, but the impact of these drugs in the trends of peptic ulcer or complications is not known.
In this study, we have analysed trends in both peptic ulcer diagnosis and peptic ulcer complications over recent years in a defined population with a high prevalence of H. pylori infection. In addition, we have analysed trends in the rate of H. pylori infection and the use of both pro- and anti-ulcerogenic drugs that may affect these trends.
Background: It is unknown whether the incidence of peptic ulcer changes in areas with a high prevalence of Helicobacter pylori infection.
Aim: To determine trends in peptic ulcer complications in a community with a high prevalence of H. pylori infection.
Methods: New endoscopic diagnoses of peptic ulcers and their complications from 1985 to 2000 were obtained. H. pylori infection in the adult population, the number of prescriptions for anti-secretory drugs and non-steroidal anti-inflammatory drugs were also evaluated.
Results: Although the global prevalence of H. pylori infection remains high in this population (>60%), a 41.4 to 25.4% decrease in the incidence of peptic ulcers and ulcer complications was observed. This was associated with a decrease in the prevalence of H. pylori infection in people under 65 years of age, a 3.5-fold increase in the number of prescriptions of proton-pump inhibitors and an increase in the number of prescriptions of non-steroidal anti-inflammatory drugs, especially coxibs.
Conclusions: In an area with a high prevalence of H. pylori infection, the incidence of peptic ulcer and associated complications is declining rapidly. This was associated with a reduction of the prevalence of H. pylori infection in the young and a widespread use of proton-pump inhibitors. The increase in the use of non-steroidal anti-inflammatory drugs, especially coxibs, has not changed the tendency.
Over the last few years a decrease in the prevalence of uncomplicated gastroduodenal peptic ulcer expressed as a decline in hospital admission rates and mortality from peptic ulcer has been reported. In contrast to these general trends, some studies have shown an increase in the mortality rates from duodenal ulcers and in the admissions for perforated peptic ulcers in western countries especially among the elderly.
The decrease in the trends of non-complicated ulcers had been attributed to a reduced prevalence of Helicobacter pylori infection because of an improvement in the socio-sanitary conditions and the antibiotic treatments to eradicate H. pylori . However, there are no data regarding trends in peptic ulcer disease in countries with a high prevalence of H. pylori . Furthermore, there are a number of potential factors, in addition to the prevalence of H. pylori infection that may affect the incidence of peptic ulcer diagnosis and that have not been properly studied or evaluated in this setting. Some of these factors are of paramount importance, as they may either increase or decrease the incidence of peptic ulcer diseases and complications. In this way, antisecretory drugs are now widely prescribed, but the potential relationship to the incidence of ulcer diagnosis has not been evaluated. On the contrary, a progressive increase in the elderly population of many western countries is associated with a parallel increase in the prescription of ulcerogenic drugs such as non-steroidal anti-inflammatory drugs (NSAIDs). More recently, safer NSAIDs (selective COX-2 inhibitors) have been introduced in the market, but the impact of these drugs in the trends of peptic ulcer or complications is not known.
In this study, we have analysed trends in both peptic ulcer diagnosis and peptic ulcer complications over recent years in a defined population with a high prevalence of H. pylori infection. In addition, we have analysed trends in the rate of H. pylori infection and the use of both pro- and anti-ulcerogenic drugs that may affect these trends.
Source...