Clinical observations on peptic ulcer in Japan. I. Clinical incidence of peptic ulcer.

Abstract

From the three different surveys undertaken: 938, 014 outpatients for the three year period from 1953 to 1955 in 100 medical and 51 surgical clinics, 70, 969 of those in Kurokawa's Clinic for the last 20 years until 1955, and 3, 151 patients with peptic ulcer confirmed radiologically and/or surgically for the nine month period in 1956 in almost all areas in Japan, the following results concerning the clinical incidence of peptic ulcer were obtained. 1. The clinical incidence of peptic ulcer in Japan is generally 2-8 per cent of the total outpatients and 10-20 per cent of those with gastrointestinal diseases in medical as well as in surgical clinics. Peptic culcer is about twice as common as gastric cancer. 2. In Japan clinically 56 per cent of peptic ulcer are gastric ulcer, 40 per cent duodenal ulcer and 4 per cent coexistence of gastric and duodenal ulcers. The gastric to duodenal ulcer ratio is 1.40. Jejunal and esophageal ulcers are under 0.5 per cent. 3. Peptic ulcer is three to five times as common in the male as in the female. 4. The sex ratio (male/female) is highest in ulcus ventriculi et duodeni, in the second place in duodenal ulcer and lowest in gastric ulcer. In gastric ulcer the nearer the ulcer is to the pylorus, the higher it is. 5. The sex ratio is high in 20 to 59 years of age. 6. In peptic ulcer the female patient is relatively frequent in urban than in rural areas, in the acute than in the chronic form, in medical than in surgical clinics, and in older than in younger age groups. 7. The incidence of peptic ulcer, on the whole, is highest absolutely in the third decade and relatively in the fifth decade in both the male and female. 8. Gastric ulcer shows high incidence over 40 years of age and duodenal ulcer under 39 years of age. 9. When the age is grouped under each five years, the number of peptic ulcer patients shows two peaks in the 25-29 and 45-49 year age groups. The two peaks are more manifest in urban areas and in the acute form. 10. In peptic ulcer patients of middle and older age groups are relatively frequent in the chronic form, in gastric ulcer and in surgical clinics. 11. Although the ratio of gastrointestinal to total diseases is high in Tohoku and low in Kanto and southward, the ratio of peptic ulcer to gastrointestinal diseases is in the inverse relation. The female patients with peptic ulcer are more frequent in the northern than in the southern areas. 12. The incidence of peptic ulcer during the last 20 years was highest at the end of World War II. 13. The increase of peptic ulcer by the war is manifest in the fourth, fifth, sixth and seventh decades in both the male and female. 14. Peptic ulcer is more frequent in the winter than in the summer. 15. The frequency of chronic ulcer is relatively high in the male, in urban areas, in middle age groups, in surgical clinics and in ulcus ventriculi et duodeni.