Incidence Of Peptic Ulcer Disease Research Articles

Formulary management of antiulcer drugs: economic considerations.

Peptic ulcer disease (PUD) is a common medical problem costing billions of dollars annually around the world. Since the availability of the first histamine H2-receptor antagonist, cimetidine, many economic analyses have been conducted to compare the impact of this drug class on resource consumption. H2-Antagonists have been shown to reduce mortality, hospitalisations, ambulatory care visits and endoscopy use caused by PUD. Because of changing risk factors and variations in diagnosis, it remains controversial whether these drugs have had a long term impact on PUD incidence and prevalence. Three studies conducted after the introduction of cimetidine showed it to reduce total direct medical healthcare expenditures, despite increases in drug costs. Studies investigating the short term treatment of PUD show mixed results because of diverse study designs and different comparator drugs. No specific therapy appears consistently superior economically because of variations in population studies, ulcer relapse rates and drug acquisition costs. However, maintenance therapy for PUD has been shown to be cost-effective. When compared with surgery--an extremely efficacious option--maintenance therapy (both daily and intermittent) is cost-effective over at least a 10-year period. Within the maintenance therapy options, daily ranitidine has been shown to be more cost-effective than intermittent therapy for up to 2 years. Omeprazole is the least costly and most efficacious treatment for gastroesophageal reflux disease (GORD or GERD) compared with ranitidine and/or lifestyle modification alone. It has also been shown that the costs for empirical treatment of GORD are offset by the costs of additional investigation of those who do not have the disease. Thus the decision of whether to treat empirically should be based on physician and patient preferences, and not on costs. The use of misoprostol for ulcers caused by nonsteroidal anti-inflammatory drugs is somewhat controversial. Three studies examining the short term (3-month) costs of misoprostol generally show it to be cost saving or cost neutral. Misoprostol is consistently more cost beneficial in elderly or other high risk patients. Results are highly sensitive, however, to several parameters, such as patient type, ulcer severity and rate, drug costs and patient compliance. One study examining prophylaxis using misoprostol over 1 year showed it to be a generally expensive therapy for primary prevention, but was more cost effective for those with a proven GI bleed in the previous year.(ABSTRACT TRUNCATED AT 400 WORDS)

Peptic ulcer disease following renal transplantation in the cyclosporine era

Peptic ulcer disease (PUD) remains a well-known sequela of renal transplantation, and, when complications occur, morbidity and mortality can be significant. For this reason, all patients at our center undergo a pretransplant upper gastrointestinal series (UGI). Patients with evidence of active ulcer disease on UGI and/or a history of PUD undergo upper gastrointestinal endoscopy and do not undergo transplantation until healing is demonstrated. Following transplantation, antiulcer prophylaxis is utilized for 6 weeks (in patients without pretransplant PUD) or 3 months (in patients with pretransplant PUD). To help define the incidence and significance of PUD in the cyclosporine era, as well as the value of pretransplant screening and posttransplant ulcer prophylaxis, a retrospective chart analysis of 254 patients who underwent renal or renal/ pancreas allograft transplanted between January 1984 and December 1989 was accomplished. Twenty-six patients (10%) presented with symptomatic PUD at a mean of 7.8 months posttransplant. The incidence of PUD was 10% in patients with a negative pretransplant history and UGI, 15% in patients with a positive pretransplant history and negative UGI and endoscopy, and 0% in patients with a positive pretransplant history and UGI. Age, sex, primary disease, donor source, and number of rejection episodes were not significantly different in recipients with or without PUD. At the time of presentation, 23 patients (88%) had completed their antiulcer prophylaxis. Four patients (15%) died secondary to ulcer disease including two of three (66%) following surgical treatment and two of 23 (9%) during medical treatment. Posttransplant PUD continues to result in significant morbidity and mortality in the cyclosporine era. Pretransplant screening, including UGI and endoscopy, is not a reliable predictor of posttransplant, symptomatic PUD. Based on this study, it is concluded that all patients should receive longer periods of antiulcer prophylaxis, independent of previously defined pre- and posttransplant risk factors.

UPPER GASTROINTESTINAL ENDOSCOPY IN OCTOGENARIANS

SUMMARYA retrospective study of upper gastrointestinal endoscopy (GIE) in 217 octogenarians performed over a two‐year period in a district general hospital was carried out. It showed that upper GIE in octogenarians is as safe and easy as in other age groups, and provides more useful information. Patients were referred mainly by the geriatricians for elective endoscopy, reflecting the growing recognition of the value of elective upper GIE in the very elderly.The incidence of peptic ulcer disease as a cause of upper GI bleeding was much less than previously reported. Thirty‐nine patients with upper GI haemorrhage had an endoscopy within 24 hours. We believe that this helps to identify patients with a high risk of mortality and those who might benefit from early surgery. Eighty per cent of the patients had one or more associated diseases, but there were no complications from endoscopy. We would like to emphasise that there is no contraindication for upper GIE in very elderly patients.

Correction: Incidence of peptic ulcer disease in Gothenburg, 1985

Correction: Incidence of peptic ulcer disease in Gothenburg, 1985

Incidence of peptic ulcer disease in Gothenburg, 1985

Incidence of peptic ulcer disease in Gothenburg, 1985

Incidence of peptic ulcer disease in Gothenburg, 1985.

To determine the incidence and age distribution of peptic ulcer disease in adults in Gothenburg. Retrospective study of patients with symptoms over one year. All gastroenterology and x ray departments. Any patient found to have an active ulcer crater during 1985. Sex, age, past history of gastrointestinal ulcers, and smoking habit. In 1985, 1402 peptic ulcers were diagnosed in 1137 adults. Over half (403; 54%) of the ulcers in men and 393 (60%) ulcers in women were in patients aged over 60. All types of ulcer showed increasing incidence with age. The sex ratio of patients aged 40-50 with peptic ulcers was 1:1. Nearly half (109; 48%) of ulcers diagnosed for the first time in men and 129 (57%) of such ulcers in women were in patients aged over 60. Elderly men and women were also more likely to develop haemorrhage. In Gothenburg there is a surprisingly high incidence of peptic ulcer disease, which increases considerably with age, possibly explained by the availability of modern diagnostic techniques as 1121 (80%) ulcers had been diagnosed by gastroscopy. Compared with earlier studies there was no difference in the incidence between men and women aged 40-50.

Antiinflammatory drugs and gastric mucosal damage

N ONSTEROIDAL antiinflammatory drugs (NSAIDs) are among the most often used medications in the United States and throughout the world. Fifteen to 20 billion aspirin tablets are consumed each year in the United States.’ Prescriptions for nonsalicylate NSAIDs represented over 4% of the total prescription market in 1983, with consumers spending over a billion dollars for these medications.’ Approximately 3% of the United States population requires treatment for a rheumatic disorder, and NSAIDs are prescribed in most types of noninfectious arthritis.3,4 NSAIDs may cause gastrointestinal (GI) symptoms, erosions and/or ulcers, and upper GI tract bleeding. Therefore, gastric mucosal damage resulting from NSAID use is potentially a major health problem. Corticosteroids are used in a wide variety of medical conditions, including rheumatoid arthritis (RA), bronchial asthma, allergic disorders, and dermatologic diseases. The relationship of corticosteroids to gastric mucosal damage is controversial. Corticosteroids may increase the incidence of peptic ulcer disease and GI hemorrhage’ and potentiate gastric mucosal injury when used in combination with NSAIDs such as aspirin.6*7 This review is divided into two sections. The first part surveys data regarding NSAID induced gastric mucosal injury, and the second portion discusses the role of corticosteroids in causing gastric mucosal damage.

Circannual and circa-hemiannual rhythms of basal and stimulated gastric secretion in conscious cats.

Conscious cats equipped with a gastric fistula and a denervated Heidenhain pouch were submitted to weekly measurements of the basal and pentagastrin-stimulated gastric secretion for 1 to 14 years. Rhythms of basal secretion were documented in 37 cats for the group studies, in 25 cats only for the individual studies which required at least whole year data. Twelve-month or 6-month rhythms were detected for each variable studied, i.e. volume, acid, pepsin, fucose and uronic acid outputs in the group studies, with peaks for volume, acid and pepsin in Winter, peaks for uronic acid in Spring and Fall indicating different rhythms for oxyntic, chief and mucous cells. Individual studies detected rhythms in 25% of the analyses, and demonstrated male and female and cat to cat differences. Spectral analysis in 3 cats confirmed the differences in the individual rhythms with prominent peaks differing from 365 days in 50% of the cases. Chronopharmacological responses to pentagastrin were documented for volume, acid and pepsin outputs in 5 male and 6 female cats. Group analysis detected a Winter acrophase for volume and acid secretion and a Summer acrophase for pepsin secretion. Analysis of the stimulated response data showed interindividual variation but a higher percentage of detection for rhythms, i.e. 38% for all variables and 50% for pepsin secretion. Different rhythms in acid and pepsin secretion documented in individual studies could provide the basis of a better understanding of the discrepancies reported in the literature concerning the seasonal incidence of peptic ulcer disease.

Circannual and Circa-Hemiannual Rhythms of Basal and Stimulated Gastric Secretion in Conscious Cats

Conscious cats equipped with a gastric fistula and a denervated Heidenhain pouch were submitted to weekly measurements of the basal and pentagastrin-stimulated gastric secretion for 1 to 14 years. Rhythms of basal secretion were documented in 37 cats for the group studies, in 25 cats only for the individual studies which required at least whole year data. Twelve-month or 6-month rhythms were detected for each variable studied, i.e. volume, acid, pepsin, fucose and uronic acid outputs in the group studies, with peaks for volume, acid and pepsin in Winter, peaks for uronic acid in Spring and Fall indicating different rhythms for oxyntic, chief and mucous cells. Individual studies detected rhythms in 25% of the analyses, and demonstrated male and female and cat to cat differences. Spectral analysis in 3 cats confirmed the differences in the individual rhythms with prominent peaks differing from 365 days in 50% of the cases. Chronopharmacological responses to pentagastrin were documented for volume, acid and pepsin outputs in 5 male and 6 female cats. Group analysis detected a Winter acrophase for volume and acid secretion and a Summer acrophase for pepsin secretion. Analysis of the stimulated response data showed interindividual variation but a higher percentage of detection for rhythms, i.e. 38% for all variables and 50% for pepsin secretion. Different rhythms in acid and pepsin secretion documented in individual studies could provide the basis of a better understanding of the discrepancies reported in the literature concerning the seasonal incidence of peptic ulcer disease.

Peptic ulcer in rheumatoid arthritis--intrinsic or related to drug therapy?

The reported incidence of peptic ulcer disease (PUD) in patients with rheumatoid arthritis (RA) is higher than that of the general population. Unusual susceptibility to PUD in RA, independent of therapy, has been suggested. To compare RA patients with others who had similar drug exposure but no known predisposition to PUD, 120 patients hospitalized for treatment of severe arthritis (65 with RA, 55 with osteoarthritis) were assessed by questionnaire for PUD history, drug history and other relevant variables. The relationship of PUD to sex distribution, smoking, alcohol consumption and anti-inflammatory therapy followed expected patterns. We found high but similar PUD rates in RA and osteoarthritis (OA) patients (RA 15%, OA 18%). This suggests that a common factor (probably drugs) is responsible. We feel that the documented high incidence of PUD in RA is most probably related to drug therapy. Available methods cannot determine if PUD ever occurs as a primary manifestation of RA.

The incidence of peptic ulcer disease related to occupation in the northern part of Norway. A prospective epidemiological and radiological study.

From a prospective epidemiological and radiological study of peptic ulcer disease in the northern part of Norway, relations between occupation and the occurrence of new peptic ulcers are presented. Over a 3-year period 1861 patients with dyspeptic complaints, 557 women and 1304 men belonging to 12 different occupational groups, were studied. Special attention was paid to the fishing population, constituting 2488 men and only 55 women. In the period studied 87 gastric ulcers and 118 duodenal ulcers were found. A statistically significantly higher incidence of both gastric and duodenal ulcers was found in fishermen than in the other groups. Furthermore, significantly higher incidences of duodenal ulcers were found in men occupied in 'land or water transport'. Compared with the total male population at risk in the area studied, significantly higher incidences were found for duodenal ulcer in fishermen. The present study confirms prior reports both from Scotland and from North Norway, showing an increased incidence of peptic ulcers in the fishing population.

Cluster Headache — Clinical Findings in 180 Patients

Anamnestic data and clinical features were accurately investigated in 180 patients with cluster headache; 161 were episodic sufferers and 19 were chronic. A significantly high familial incidence of coronary heart disease was found. The patients' medical history revealed a significantly high incidence of peptic ulcer disease and head injury with brain concussion. It is stressed that the side on which head injury took place is very frequently the same side on which cluster headache is located, although the latency between the two events appears to be a long one. The study of timing of cluster periods suggests, for some patients, a constant, typical temporal pattern not necessarily related to seasons or the months of of the year. Cluster attacks frequently occur during certain periods of the day (onset being most frequent between 1 and 3 p.m.). Cluster headache cannot be considered as a nocturnal headache.

Healing of Aspirin-Associated Peptic Ulcer Disease Despite Continued Salicylate Ingestion

Patients who have rheumatic disease and who are undergoing long-term aspirin therapy have a high incidence of peptic ulcer disease. Whether it is possible to heal long-term aspirin-related peptic ulcer disease if aspirin intake is continued is unknown. Nine patients with rheumatic disease who were receiving long-term aspirin therapy and who had 15 endoscopically verified gastric and/or duodenal ulcers were studied. Patients were treated daily with 1,200 mg of cimetidine plus at least 120 mL of antacid (Mylanta II), while continuing aspirin therapy at the same dose and type. By eight weeks, 14 ulcers had healed. This study shows that some aspirin-associated peptic ulcers can be healed, despite continued aspirin intake, by intensive medical therapy aimed at lowering intragastric acidity.

Role of the small bowel in regulating serum gastrin and gastric inhibitory polypeptide (GIP) levels and gastric acid secretion.

An increase in gastric acid secretion after resection or bypass of the small bowel has been described by several authors in man and dogs1,2,3. Furthermore, a high incidence of peptic ulcer disease has been observed in patients with small bowel resection4,5. The mechanism which induces gastric hypersecretion after exclusion of large parts of the small bowel from food passage is still poorly understood. Several authors have described hypergastrinemia after small bowel exclusion or bypass, which may be caused by either a decrease in catabolism or a diminished release of inhibitors from the small intestine6,7,8. One of the physiologically important inhibitors of gastric acid secretion may be the gastric inhibitory polypeptide (GIP) which is released from the duodenum and jejunum after food intake and shows besides its insulinotropic effect a strong inhibition of stimulated acid secretion in dogs9.

Roux-en-Y hepaticojejunostomy: a reappraisal of its indications and results.

A critical evaluation is made of 131 patients submitted to choledocho or hepaticojejunostomy. The main indications for hepaticojejunostomy were iatrogenic strictures of CBD (60 patients), and choledocholithiasis with markedly dilated duct (41 patients). The overall mortality rate was 4% representing principally renal hepatic failure, bile peritonitis and bleeding. The complications following hepaticojejunostomy included only in one case biliary fistula which required reoperation. The long-term results of 80 patients available for a followup study were as follows: 63 patients (78.7%) were symptom-free at 2-13 years followup; 8 patients had brief episodes of cholangitis which responded to antibiotic and corticosteroid treatment; 9 patients required reoperation for stricture of anastomosis. These overall results are a strong argument for hepaticojejunostomy which, compared with choledochoduodenostomy, avoids the hazards of the so-called sump syndrome and of the reflux of enteric contents in the CBD. An increased incidence of peptic ulcer disease in the patients submitted to hepaticojejunostomy was not observed. In very high strictures and in reinterventions anastomosis between left hepatic duct and Roux-en-Y jejunal limb was carried out. The results achieved with this technique, which was performed in 26 patients, were about the same following hepaticojejunostomy.

Crohn's disease of the stomach.

Of 76 cases of Crohn's disease of the gastrointestinal tract, six demonstrated involvement of the stomach. Roentgenographic findings in the stomach depend on the stage of the disease—inflammatory or cicatricial. In the inflammatory phase radiographs show hypertrophy of mucosal folds, a cobblestone appearance and multiple small ulcerations. The stenotic phase shows tubular narrowing of the distal antrum. Change in stomach anatomy and/or increased incidence of peptic ulcer disease is associated with Crohn's disease of the stomach. Involvement of the stomach by Crohn's disease is not as rare as formerly thought.

Upper gastrointestinal disease in rheumatoid arthritis.

Upper gastrointestinal series were done in 140 consecutive patients with rheumatoid arthritis, irrespective of the presence or absence of symptoms suggesting upper gastrointestinal disease. In addition, intraluminal pH and manometric studies of the esophagus and esophagoscopy were done in 66 of these 140 patients. Gastric ulcers were found in 12 patients, and duodenal ulcers in 27, an incidence of peptic ulcer disease of 27.8%. The higher incidence of ulcer disease was found in patients on corticoid and in combination with indomethacin or phenylbutazone. No ulcer occurred in patients receiving gold therapy. Of the 66 patients who had esophageal motility study, a significantly lower mean amplitude of peristaltic contractions was noted in the lower two-thirds of the esophagus. The resting pressure in the inferior esophageal sphincter was also significantly lower than in the control group. However, no correlation was found between these two parameters and the duration or ARA stages of rheumatoid arthritis. It is impossible to determine whether the upper gastrointestinal dysfunction observed in these patients is another systemic manifestation of the rheumatoid disease or due to drugs.

Hospital based analytic study of peptic ulcer disease in patients with dyspeptic symptoms

Peptic ulcer disease is one of the most common diseases prevalent in developing country like Nepal and with availability of endoscopy there have been increase in diagnosis and therapeutic use of endoscopy. The aim of this study is to investigate the prevalence of peptic ulcer disease in patient who came for upper gastrointestinal endoscopy in Kathmandu Medical College Teaching Hospital. All patients who were referred to department of endoscopy from outpatient department (OPD) and inpatient department with symptoms like dyspepsia, upper GI bleeding were included from August 2004 to August 2008. A total of 2761 patient were evaluated, with mean age group of 40.57 years (range 8- 95 years) and with sex distribution of male 1353 (49%) and female 1408 (51%) and racial difference into Aryan 2050 (74.2%) and Mongoloid 771 (25.8%). There were 983 patients (35.60%) with peptic disease which includes erosive gastritis, non erosive gastritis, duodenitis and gastroduodenitis without obvious ulcer. The prevalence of peptic disease with or without ulcer was more common in age group of 20- 49 years (n= 764, 27.67 %) with 70 patient with gastric ulcer (2.5%) and 50 patient with duodenal ulcer (1.8%). There was no significant racial difference among incidence of peptic ulcer (P value= 0.527). Peptic ulcer disease is a significant cause of morbidity in urban population of Nepal with more prevalent of erosive diseases in productive age group (20-49 years). However both male and female have equal incidence of peptic ulcer disease and there was no significant racial difference in its incidence.