Changing trends in peptic ulcer prevalence in a tertiary care setting in the Philippines: a seven-year study

Forty years of Helicobacter pylori infection and changes in findings at esophagogastroduodenoscopy

BACKGROUND

It is 40 years since the discovery of Helicobacter pylori infection. Over that time major changes have occurred in esophagogastroduodenoscopy (EGD) findings. The aim of this review is to describe these changes, and the important role H. pylori infection has played in their evolution.

METHODS

References were identified through searches of PubMed using the search terms-endoscopy time trends, peptic ulcer disease, gastroesophageal reflux disease, upper gastrointestinal cancer, gastric polyps, H. pylori, eosinophilic gastrointestinal disorders, and celiac disease, from 1970 through December 2021.

RESULTS

The prevalence of H. pylori infection has fallen and consequently, H. pylori-positive peptic ulcer disease has become rare. Gastroesophageal reflux disease is now the commonest disorder diagnosed at EGD, and Barrett's esophagus has increased in parallel. Cancer of the distal stomach has fallen while esophageal adenocarcinoma and reflux-related cardia cancer have risen. Gastric polyps have changed from hyperplastic and adenomas to sporadic fundic gland polyps. Antimicrobial resistance has made H. pylori infection more difficult to eradicate. Eosinophilic gastrointestinal disorders, particularly eosinophilic esophagitis, have emerged as important new allergic disorders. Celiac disease has changed and increased.

CONCLUSIONS

EGD findings appear to have changed from features suggesting a H. pylori-positive "phenotype" 40 years ago to a H. pylori-negative "phenotype" today. These changes have major implications for the management of gastrointestinal disorders.

Age is the only predictor for upper gastrointestinal malignancy in Chinese patients with uncomplicated dyspepsia: a prospective investigation of endoscopic findings

Background

Dyspepsia is a common cause of physician visits. If and when endoscopy should be performed depend on the regions and the populations. This study aimed to identify the current risk factors predictive of upper gastrointestinal malignancy or peptic ulcer in China with high prevalence of gastric cancer.

Methods

A questionnaire was conducted among consecutive outpatients undergoing their first esophagogastroduodenoscopy for dyspepsia. Symptoms other than alarm symptoms in this study were defined as uncomplicated dyspepsia.

Results

4310 outpatients (mean age 44, median 42, range 14–86) were included in the final analyses. Significant pathology was found in 13.8% (595/4310) patients including peptic ulcer (12.3%) and upper gastrointestinal malignancy (1.5%). Age, male sex and alarm symptoms were significantly associated with malignancy. The age cut-off identified for upper gastrointestinal malignancy was 56 years among patients with uncomplicated dyspepsia, which was similar to the combined cutoff of age and gender.

Conclusions

Age should be considered as the primary predictor for upper gastrointestinal malignancy in Chinese patients with uncomplicated dyspepsia. 56 could probably be the optimal age to identify those lesions in this population. Trial registration: Chictr.org (ChiCTR2000040775).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12876-021-01951-x.

Falciform ligament use in perforated duodenal ulcer repair: a case report and literature review

Acute perforated duodenal ulcers are considered one of the most encountered emergency surgical conditions leading to mortality. Different approaches have been proposed for management based on the clinical status of the patient. The use of omental patch closure is widely accepted either via an open or laparoscopic approach. However, not all patients are candidates owing to the availability and viability of the greater omentum. In these patients, the falciform ligament can be used as an alternative and efficient method for repair. In this case, we present a male patient with a perforated ulcer in the first part of the duodenum which was managed by falciform ligament patch instead of the usual omental patch. In cases of a deficient or unhealthy greater omentum, or if it cannot be brought in the upper part of the abdominal cavity due to severe adhesions, the falciform ligament can be used efficiently in the closure of perforated duodenal ulcer.

Efficacy of Zinc Sulfate in Peptic Ulcer Disease: A Randomized Double-Blind Clinical Trial Study

INTRODUCTION

Peptic ulcer is a common disease that affects millions of people worldwide. Considering its global prevalence finding new approach for treating is important.

AIM

The aim of this study was to investigate the effect of zinc sulfate on gastric and duodenal ulcer treatment.

MATERIALS AND METHODS

This double-blind clinical trial study was done on 90 patients who were admitted to the gastrointestinal endoscopy clinic of Tohid hospital in Sanandaj, Iran. All patients were diagnosed with gastric and duodenal ulcers. They were randomly divided into two-intervention and control groups, using block randomization with block sizes of 4. Patients and researcher were unaware of the grouping. To assess the level of zinc, blood samples were taken. In case of positive Rapid Urease Test (RUT), triple therapy regimen including amoxicillin, clarithromycin and omeprazole was administered for two weeks. For intervention group in addition to "triple therapy", an oral dose of Zinc Sulfate 220mg capsules were administered daily, while the control group received placebo capsules.

RESULTS

A total of 54.5% and 57% of the patients in the intervention and control groups had gastric ulcer respectively. The Rapid Urease Test (RUT) result of 72.7% of intervention group and 83.3% of control group was positive (p = 0.24). Serum zinc level of 20.9% of intervention group and 35.7% of control group was lower than the normal level (p = 0.13). The mean of serum zinc level of intervention group and control group were 81.9 and 78.9 mg dL respectively (p = 0.4). After intervention, peptic ulcer in 81.8% of the intervention group and 83.3% of the control groups were improved (p= 0.85). Response to treatment were higher in patients with normal zinc levels compared to patients with abnormal levels (77.5% vs. 22.5%, p=0.019).

CONCLUSION

A daily dose of 220mg zinc sulfate was not significantly effective on peptic ulcer. However, patients with normal zinc levels had better ulcer treatment.

Trends in upper gastrointestinal diagnosis over four decades in Lusaka, Zambia: a retrospective analysis of endoscopic findings

Background and aims

There a shortage of robust information about profiles of gastrointestinal disease in sub-Saharan Africa. The endoscopy unit of the University Teaching Hospital in Lusaka has been running without interruption since 1977 and this 38-year record is largely intact. We report an analysis of endoscopic findings over this period.

Methods

Written endoscopy records from 29th September 1977 to 16th December 2014 were recovered, computerised, coded by two experienced endoscopists and analysed. Temporal trends were analysed using tables, graphs, and unconditional logistic regression, with age, sex of patient, decade, and endoscopist as independent variables to adjust for inter-observer variation.

Results

Sixteen thousand nine hundred fifty-three records were identified and analysed. Diagnosis of gastric ulcer rose by 22 %, and that of duodenal ulcer fell by 14 % per decade. Endoscopically diagnosed oesophageal cancer increased by 32 % per decade, but gastric cancer rose only in patients under 60 years of age (21 % per decade). Oesophageal varices were the commonest finding in patients presenting with haematemesis, increasing by 14 % per decade in that patient group. Two HIV-related diagnoses, oesophageal candidiasis and Kaposi’s sarcoma, rose from almost zero to very high levels in the 1990s but fell substantially after 2005 when anti-retroviral therapy became widely available.

Conclusions

This useful dataset suggests that there are important trends in some endoscopic findings over four decades. These trends are not explained by inter-observer variation. Reasons for the divergent trends in incidence of peptic ulceration and apparent trends in diagnosis of upper gastrointestinal cancers merit further exploration.

The changing pattern of upper gastrointestinal disorders by endoscopy: data of the last 40 years

Objectives. We have investigated the changes in the incidence of various diagnoses that have been made in the endoscopy unit throughout the last 40 years. Methods. In this study, changes in the incidence of endoscopic diagnosis in upper gastrointestinal system between 1970 and 2010 were evaluated. Their diagnosis, age, and gender data were entered into the Excel software. Results. Of the 52816 cases who underwent esophagogastroduodenoscopy in the 40-year time period, the mean age was 48.17 ± 16.27 (mean ± SD). Although overall more than half of the patients were male (54.3%), in 1995 and after a marked increase was seen in the proportion of female gender (51–55%). The presence of hiatal hernia, reflux esophagitis, and the number of Barrett's esophaguses significantly increased. Erosive gastritis showed gradual increase, while the number of gastric ulcers decreased significantly. The presence of gastric and esophageal cancer significantly decreased. The number of duodenal ulcers significantly decreased. Conclusion. We detected that the incidences of esophagitis, Barrett's esophagus, and erosive gastritis significantly increased while the incidences of gastric/duodenal ulcer and gastric/esophageal cancer decreased throughout the last 40 years.

Global disease burden of conditions requiring emergency surgery

BACKGROUND

Surgical disease is inadequately addressed globally, and emergency conditions requiring surgery contribute substantially to the global disease burden.

METHODS

This was a review of studies that contributed to define the population-based health burden of emergency surgical conditions (excluding trauma and obstetrics) and the status of available capacity to address this burden. Further data were retrieved from the Global Burden of Disease Study 2010 and the University of Washington's Institute for Health Metrics and Evaluation online data.

RESULTS

In the index year of 2010, there were 896,000 deaths, 20 million years of life lost and 25 million disability-adjusted life-years from 11 emergency general surgical conditions reported individually in the Global Burden of Disease Study. The most common cause of death was complicated peptic ulcer disease, followed by aortic aneurysm, bowel obstruction, biliary disease, mesenteric ischaemia, peripheral vascular disease, abscess and soft tissue infections, and appendicitis. The mortality rate was higher in high-income countries (HICs) than in low- and middle-income countries (LMICs) (24.3 versus 10.6 deaths per 100,000 inhabitants respectively), primarily owing to a higher rate of vascular disease in HICs. However, because of the much larger population, 70 per cent of deaths occurred in LMICs. Deaths from vascular disease rose from 15 to 25 per cent of surgical emergency-related deaths in LMICs (from 1990 to 2010). Surgical capacity to address this burden is suboptimal in LMICs, with fewer than one operating theatre per 100,000 inhabitants in many LMICs, whereas some HICs have more than 14 per 100,000 inhabitants.

CONCLUSION

The global burden of surgical emergencies is described insufficiently. The bare estimates indicate a tremendous health burden. LMICs carry the majority of emergency conditions; in these countries the pattern of surgical disease is changing and capacity to deal with the problem is inadequate. The data presented in this study will be useful for both the surgical and public health communities to plan a more adequate response.

Time trends in epidemiology of peptic ulcer disease in India over two decades

BACKGROUND

Epidemiology of peptic ulcer disease (PUD) in India differs from that in the West. It may have undergone a change with recent improvement in hygiene and availability of potent antisecretory and ulcerogenic drugs. We therefore tried to assess time-trends in the frequency of PUD over the past two decades.

METHODS

Records of patients with uninvestigated dyspepsia and no alarm symptoms who had undergone upper gastrointestinal endoscopy at our institution during the years 1988 (n = 2,358), 1992 (n = 2,240), 1996 (n = 5,261), 2000 (n = 7,051), 2004 (n = 5,767) and 2008 (n = 7,539) were retrospectively reviewed. The frequencies of duodenal and gastric ulcer disease in these groups were compared.

RESULTS

Of the 30,216 patients (age:41.7±12.7 years, 34 % females) during the six study periods, 2,360 (7.8 %) had PUD. The frequencies of both duodenal ulcer and gastric ulcer showed a decline from 1988 to 2008, i.e. from 12 % to 2.9 % and 4.5 % to 2.7 %, respectively (p-value <0.001 for trend for each). The decline was more marked for duodenal ulcer, and the ratio of duodenal to gastric ulcer declined from 2.7 in 1988 to 1.1 in 2008.

CONCLUSIONS

The epidemiology of PUD in India may have changed in the past two decades with the incidence of duodenal ulcer declining more rapidly than that of gastric ulcer.

Epidemiology of peptic ulcer disease: endoscopic results of a systematic investigation in iran

BACKGROUND

Peptic ulcer disease is a multifactorial health problem affecting almost all populations worldwide. Large scale population-based studies are crucial to understanding its scope and specifications in various nations. We aimed to explore environmental risk factors of peptic ulcer disease in the first population based study in Ardabil, Northwest Iran.

METHODS

This study was a part of a larger survey on upper gastrointestinal tract health conducted in Ardabil and Meshkinshahr with a total catchment area population of 600,000 persons during 2000-01. Using a random sampling proportional to place of residence, 1122 persons aged 40 or elder were selected. 1011 (90.1%) accepted participation and underwent a comprehensive medical examination and a systematic upper gastrointestinal endoscopy. Point prevalence of peptic ulcers was correlated to various life style risk factors.

RESULTS

Gastric and duodenal ulcers were identified in 33 (3.26%) and 50 (4.94%) participants, making an overall prevalence of 8.20%. Based on multivariable logistic regression analyses, H.pylori infection (OR 3.1, 95% CI: 2.1-4.7), Smoking (OR 1.8, 95% CI: 1.1-6.8), and chronic intake of NSAIDs (OR 2.8, 95% CI: 1.3-4.4) were main risk factors of gastric ulcer. For duodenal ulcer, in addition to H.pylori infection (OR 5.6, 95% CI: 1.9-8.8) and Smoking (OR 2.3, 95% CI: 1.4-6.5), male gender (OR 3.6, 95% CI: 1.2-5.8) and living in an urban area (OR 1.9, 95% CI: 1.1-5.2) were among significant risk factors.

CONCLUSION

This is the first population-based endoscopic study in North West of Iran reporting accurate point prevalence of peptic ulcer disease. The rate of 3.3% for gastric ulcer and 4.9% for duodenal ulcers are substantially lower than the estimates reported in Asian population-based endoscopic studies but higher than European reports.

High prevalence of duodenal ulcer in a tertiary care hospital in the city of São Paulo, SP, Brazil

CONTEXT: In spite of Helicobacter pylori infection being the etiological cause of peptic ulcer and its high prevalence in Brazil, the prevalence of peptic ulcer disease has been poorly studied. OBJECTIVES: To verify the peptic ulcer disease prevalence in patients of a tertiary care hospital. METHODS: Diagnostic findings from 1,478 consecutive endoscopies were correlated with the urease test results for H. pylori infection diagnosis and demographic data in a total of 3,779 endoscopies performed in 2005. The mean age of the patients was 51.14 ± 16.46, being 613 (41.5%) men. RESULTS: Peptic ulcer was diagnosed in 494 (33.4%) patients with a mean age of 54.86 ± 14.53, 205 (52%) were men, being 391 (26.5%) duodenal ulcer and 103 (7%) gastric ulcer. Normal endoscopy was found in 272 (18.4%) patients with a mean age of 38.4 ± 15.22, being 49 (18%) men. The comparison of peptic ulcer group with the patients that had normal endoscopy revealed that H. pylori infection [P = 0.005; OR = 1.70; 95% CI = 1.17-2.47][ign], male gender [P<0.0001; OR = 5.53; 95%CI = 3.67-8.34][ign] and older age [P<0.0001; OR = 1.08; 95%CI = 1.06-1.09] increased the risk of peptic ulcers. The overall H. pylori prevalence was 53% (786). CONCLUSIONS: Prevalence of duodenal ulcer is high in a Brazilian population that had H. pylori infection associated with older age and male gender as important determinants to gastrointestinal diseases outcome. Future prospective studies should confirm these findings.

Diagnosis and treatment of dyspeptic patients in Japan

BACKGROUND AND AIM

Although functional gastrointestinal (GI) disorders has been paid more attention recently in Japan, similar to Western countries, the clinical characteristics of dyspeptic patients, current diagnostic approach to dyspeptic patients and current standard treatments for dyspeptic patients are not well known in Japan. This review, in the most part, summarizes two topics about Japanese dyspeptic patients. The first topic is the pros and cons of the diagnosis of Japanese dyspeptic patients using Rome III classification on the basis of our data and the second topic deals with standard treatments for dyspeptic patients-especially by primary care doctors in Japan.

METHODS

We conducted a PubMed search using the following key words alone or in combination: functional dyspepsia (FD), medical treatment, Rome III classification and Japanese.

RESULTS

The Rome III classification for FD does not adequately identify a large proportion of Japanese dyspeptic patients, primarily due to their earlier presentation for medical evaluation. There are many kinds of options for the treatment of FD in Japan: proton-pump inhibitors, histamine H(2) receptor antagonists, mucoprotective agents, Japanese traditional herbal medicines, Helicobacter pylori eradication therapy and prokinetics. Under the current situation, Japanese primary care doctors choose drugs according to each subtype of FD, which means that they prescribe medicine according to the pathogenesis of each patient.

CONCLUSIONS

While the Rome III classification seems logical, some aspects need further evaluation for Japanese dyspeptic patients. Japanese primary care doctors choose drugs appropriately based on the pathogenesis of FD. However, efforts to further elucidate underlying pathophysiologic mechanisms and identify the appropriate patient population using modified Rome classification will be required.

Changes of upper gastrointestinal symptoms and endoscopic findings in Japan over 25 years

BACKGROUND AND AIMS

In Japan, the prevalence of Helicobacter pylori infection has decreased recently, but there has been little longitudinal research on the changes of symptoms and endoscopic findings over many years. The aim of this study was to evaluate the changes in endoscopic findings and symptoms over time in patients undergoing upper gastrointestinal endoscopy for assessment of upper abdominal symptoms.

METHODS

Over a period of 25 years, between 1981 and 2005, we performed three investigations (1981-2, 1990-1 and 2004-5) on the symptoms and endoscopic findings of patients undergoing endoscopy at Kawasaki Medical School Hospital for the assessment of upper abdominal symptoms.

RESULTS

The most common complaint for all ages was "discomfort and/or pain". Over time, the percentage of patients complaining of "heartburn" increased almost 5-fold. With respect to endoscopic findings, the prevalence of peptic ulcers decreased, whereas the detection of no abnormalities and the detection of erosive esophagitis increased.

CONCLUSION

In the future in Japan, there will be fewer patients with peptic ulcers and more patients with gastro-esophageal reflux disease or dyspeptic patients who display no endoscopic abnormal findings.

Epidemiology of peptic ulcer disease: endoscopic results of the systematic investigation of gastrointestinal disease in China

OBJECTIVES

Complications of peptic ulcer disease (PUD) are common in China. Population-based estimates of the prevalence of PUD are needed to quantify and characterize the population at risk of these complications.

METHODS

As part of a large epidemiological study, 3,600 randomly selected residents of Shanghai (aged 18-80 years) were asked to undergo endoscopy and to provide blood samples for Helicobacter pylori serology. All participants also completed a general information questionnaire and Chinese versions of the reflux disease questionnaire (RDQ) and Rome II questionnaire. Associations between PUD and other factors were analyzed using a multiple logistic regression model.

RESULTS

In total, 3,153 individuals (87.6%) completed the survey. All underwent blood tests, and 1,030 patients (32.7%) agreed to undergo endoscopy. Results from 1,022 patients were suitable for analysis. In all, 176 participants (17.2%) had PUD (62 with gastric ulcer; 136 with duodenal ulcer). The prevalence of H. pylori infection was 73.3% in the total population and 92.6% among those with PUD. H. pylori infection was associated with the presence of PUD (odds ratio (OR), 6.77; 95% confidence interval (CI), 2.85-16.10). The majority (72.2%) of individuals with PUD had none of the upper gastrointestinal symptoms assessed by the RDQ. PUD was not significantly associated with symptom-defined gastroesophageal reflux disease (GERD) (OR, 0.80; 95% CI, 0.32-2.03), reflux esophagitis (OR, 1.46; 95% CI, 0.76-2.79) or dyspepsia (OR, 1.69; 95% CI, 0.94-3.04).

CONCLUSIONS

The prevalence of endoscopically confirmed PUD in this Shanghai population (17.2%) is substantially higher than in Western populations (4.1%). The majority of individuals with PUD were asymptomatic.

[Risk factors for development and recurrence of peptic ulcer disease]

BACKGROUND/AIMS

Peptic ulcer disease (PUD) is one of the common gastrointestinal diseases, and its medical management has been developed so much that the incidence of its serious complications, such as bleeding and perforation, are declining significantly. Its prevalence in Korea is not definitely decreased, probably due to increasing proportion of elderly patients and their rising usage of non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin. This study was conducted to identify the risk factors for development and recurrence of peptic ulcer disease in Korea.

METHODS

From 2003 to 2008, upper gastrointestinal endoscopy and detailed personal questionnaires were performed for patients who visited Department of Gastroenterology at Seoul National University Bundang Hospital. In total, 475 PUD patients and 335 non-ulcer dyspepsia patients were included. The results of questionnaires and repeated upper gastrointestinal endoscopy at initial diagnosis time and follow-up periods were analyzed.

RESULTS

Multivariable analysis showed that male, H. pylori infection, NSAIDs use and smoking were risk factors for the development of PUD. The use of proton pump inhibitors (PPIs) and H2 receptor antagonists has significantly reduced the risk of PUD in patients who had taken NSAIDs and/or aspirin. H. pylori infection was found as the only risk factor for the recurrence of PUD.

CONCLUSIONS

For the old patients who are taking drugs, such as NSAIDs and aspirin, concomitant use of PPIs or H2 receptor antagonists should be considered to protect from the development of PUD. H. pylori eradication has been confirmed again to be essential for the treatment of PUD patients infected with H. pylori.

[Duodenal ulcer during the period of twenty years after discovering of Helicobacter pylori--experience gained at our centre]

INTRODUCTION

It is now well established that Helicobacter pylori eradication can significantly modify the natural history of peptic ulcer disease. The aim of this study was to assess the frequency of duodenal ulcer among patients endoscopically examined for dyspeptic symptoms and analyse the disease time trend during two ten-year long distinctive retrospective periods (1987-2006).

MATERIAL AND METHODS

Data were obtained through retrospective analysis of outpatients upper endoscopy reports. Full reports were available for 58,515 patients which were analysed for selected clinicopathological features in two clearly defined time periods. The first one, starting from 1987 to 1996 in which Helicobacter pylori infection was not assessed and treated accordingly and the second period from 1997 to 2006 during which the presence of Helicobacter pylori infection in certain diseases was routinely assessed and then treated with PPI based triple therapy.

RESULTS

Symptoms of dyspepsia appeared to be approximately the same as the indication for endoscopy in both periods (65.1%:63.3%). The frequency of duodenal ulcer disease significantly decreased in the second period of analysis (t=14761; p < 0.01). In both periods men had more often duodenal ulcer comparing to women (chi2 = 218.53, p < 0.01; chi2 = 21.7, p < 0.01). During the second examined period the number of women who had duodenal ulcer significantly increased comparing to the first ten-year period (chi2=17232; p < 0.01).

CONCLUSION

The test-and-treat strategy and the implementation of consensus on diagnosis and treatment of Helicobacter pylori infection resuited in a significant decrease in the frequency of duodenal ulcer disease.

Changes in the prevalence of Helicobacter pylori infection and gastrointestinal diseases in the past 17 years

BACKGROUND AND AIMS

The aim of the study was to examine whether the change in the prevalence of Helicobacter pylori infection had influenced upper gastrointestinal diseases in a recent 17-year period.

METHODS

The prevalence of H. pylori infection was examined by serum H. pylori antibody tests in the subjects undergoing annual health checks at the Social Insurance Shiga Hospital in 1998 and 2005 (142 and 242 subjects, respectively). The prevalence of H. pylori infection in 1988 was estimated by parallel translation from the prevalence in 1998. A total of 2833 records of endoscopy performed in 1988 and 2005 at Otsu Municipal Hospital were studied. The age-adjusted prevalence of peptic ulcer, gastric cancer and reflux esophagitis were compared between 1988 and 2005.

RESULTS

The age-adjusted prevalence of H. pylori infection significantly decreased in 2005 compared with 1988 (70.5-52.7%). The endoscopic records of 937 and 1246 patients in 1988 and 2005, respectively, were included in the analysis. The age-adjusted prevalence of peptic ulcer significantly decreased 0.34-fold in both men and women in 2005 compared with 1988. The age-adjusted prevalence of gastric cancer significantly decreased 0.44-fold in men, but did not change in women (0.99-fold), and overall significantly decreased 0.56-fold. The age-adjusted prevalence of reflux esophagitis significantly increased 6.6-, 2.7- and 4.8-fold in men, women and total, respectively. The increase was dominant in men aged 30-69 years.

CONCLUSION

Over the 17-year period, accompanying the decreasing prevalence of H. pylori infection, the age-adjusted prevalence of peptic ulcer and gastric cancer decreased, but that of reflux esophagitis increased.

Differences in peptic ulcer between the East and the West

PUD affects both the East and the West. The magnitude of the problem, however, varies within these regions. The study of peptic ulcer epidemiology is impeded by the paucity of general population-based data, invasiveness of diagnostic tests, and variable access to testing facilities. As such, direct comparisons of PUD epidemiology between the East and the West are difficult. The prevalence rates of H pylori are highly variable and depend greatly on the local sanitation conditions. The use of NSAIDs and aspirin is ubiquitous and increasing especially for the antiplatelet activity of aspirin in the prophylaxis of cardiovascular events. There is evidence that pharmacogenetics play a role in susceptibility to the ulcerogenic properties of NSAIDs. The prevalence of PUD parallels the risk factors, but emerging in both the East and the West is idiopathic PUD, now a substantial proportion of ulcers in areas of declining H pylori infection. Genetic polymorphisms affect the efficacy of treatment using PPIs. Local H pylori resistance rates also influence the eradication success rates.

Decrease in prevalence of Helicobacter pylori infection during a 10-year period in Brazilian children

BACKGROUND

Decreasing prevalence of H pylori infection has been reported in some countries.

AIM

To evaluate the prevalence of Helicobacter pylori infection in a 10-year period in children submitted to upper digestive endoscopy.

METHODS

It was a retrospective observational study. The records of 1,165 endoscopies performed during a 10-year period in a public hospital of the City of São Paulo, SP, Brazil, in patients up to 18-year-old. Only the first endoscopy was considered. Helicobacter pylori infection was defined by the rapid urease test, performed with one fragment of antral mucosa. Chi-square for trend has been estimated to compare Helicobacter pylori prevalence across the period.

RESULTS

The main indication for endoscopy was epigastric pain (47.4%). There were 392 patients with H pylori infection (33.6%), 12.8% being infants, 19.4% toddlers, 28.8% schoolchildren and 46.3% adolescents. Prevalence was 60.47% in the first year of the study and 30.43% in the last. Among the less than 6-year-old patients there was a decrease in infection prevalence from 25% for the 1993--6 period to 14.3% in the 2000--02 period, while among the over 12-year-old patients the decrease was from 55.5% in the first period to 39.6% in the latter. The decrease in H pylori infection prevalence was more intense within patients with epigastric pain, in which prevalence has decreased from 48.2% (92/191) in 1993--6, to 41.9% (65/155) in 1997--9 and 27.7% (57/206) in 2000--02.

CONCLUSION

The study suggests a significant decrease in the prevalence of H pylori infection regarding the studied patients. The trend was mainly observed in the younger age group and in patients with epigastric pain.

Time trends in peptic ulcer, erosive reflux oesophagitis, gastric and oesophageal cancers in a multiracial Asian population

BACKGROUND

Dramatic changes in the prevalence and pattern of gastrointestinal disease has taken place in Asia in recent years.

AIM

To compare the prevalence of duodenal (DU) and gastric ulcers (GU), erosive oesophagitis (EO), gastric cancer (GCA) and oesophageal cancer (OCA) and Helicobacter pylori infection over a 10-year interval of time in a multiracial South-East Asian population.

METHODS

Endoscopy records of first time gastroscopy in the University of Malaya Medical Centre, Kuala Lumpur, Malaysia were reviewed for 1989/1990 and 1999/2000.

RESULTS

In the period of 1989-1990, 3252 records and in 1999-2000, 4615 records were analysed. Both DU (21.1-9.5%) and GU (11.9-9.4%) had decreased significantly (P < 0.001). EO had increased significantly from 2.0% to 8.4% (P < 0.001). Both GCA and OCA had declined in the 10-year interval. Helicobacter pylori prevalence had decreased from 51.7% to 30.3% (P < 0.001).The decrease in DU and GU was seen in all racial groups. The increase in EO was most marked in Indians and the decrease in GCA in Chinese. The proportion of H. pylori-associated DU and GU had also decreased with time.

CONCLUSIONS

Peptic ulcers and H. pylori infection had declined over a 10-year period of time and showed an opposing time trend with EO, which had increased dramatically. Both GCA and OCA had declined in prevalence.

Changing epidemiology of Helicobacter pylori in Asia

As in developed societies, the prevalence of Helicobacter pylori has declined rapidly in Asia. This has been shown in both seroprevalence-based and endoscopy-based studies. While the decline in the incidence of gastric cancer has now been observed, a decrease in peptic ulcer disease has not been so clearly evident. This apparent paradox can be explained by an increase in non-H. pylori associated ulcers - such as those related to non-steroidal anti-inflammatory drugs or idiopathic ulcers. The increase of gastroesophageal reflux disease in Asia has been widely observed and commented on and its relationship to the decline in H. pylori speculated upon. However there have been few conclusive studies from Asia on this subject. While the improved diagnosis and elimination of H. pylori has contributed to its decline, a more basic change involving large segments of the Asian population must be responsible. An improvement in hygiene and living conditions that results from more affluent Asian societies is thought to be a possible cause.

Has peptic ulcer disease changed during the past ten years in Korea? A prospective multi-center study

BACKGROUND

The incidence of H. pylori-negative, idiopathic peptic ulcer disease (IPUD) seems to be increasing with the changing trends of PUD and H. pylori infection in some developed countries.

AIM

To investigate the changing trend of PUD and the prevalence ofH. pylori infection during the last decade and the prevalence of IPUD in Korea.

METHODS

We prospectively evaluated H. pylori infection and the characteristics of PUD in 895 patients with newly diagnosed PUD from September 2004 to February 2005.

RESULTS

The H. pylori infection rate in PUD was 72.0% and the proportion of IPUD was 22.2%. The proportion of gastric ulcer (GU) has significantly increased (47.8% vs. 44.3%) and the proportion of duodenal ulcer (DU) has significantly decreased (38.9% vs. 44.9%) compared with ten years ago. The changing trend in the prevalence of H. pylori infection in GU and DU showed an increase in GU (66.1% vs. 73.1%, P = 0.014) and a decrease in DU (79.3% vs. 68.1%, P = 0.001).

CONCLUSION

Compared with our results of ten years ago, there has been a significant change in the distribution of PUD and in the prevalence of H. pylori infection in GU and DU. Patients with IPUD are not uncommon in Korea.

Changing trends in gastrointestinal disease in the Asia-Pacific region

The new millennium has seen distinct changes in the pattern of gastrointestinal disease in the Asia-Pacific region. These changes are important as more than half of the world's population come from the region and therefore impact significantly on the global disease burden. The highest incidence of gastric cancer (GCA) has been reported from Asia and GCA remains a very important cancer. However time-trend studies have shown a decrease in GCA incidence in several countries in Asia. A rise in cardio-esophageal cancers as seen in the West has not been reported. On the other hand, colorectal cancer has been steadily increasing in Asia with age-standardized incidence rates of some countries approaching that of the West. The pattern of acid-related diseases has also changed. Gastroesophageal reflux disease is a fast emerging disease with an increasing prevalence of reflux esophagitis and reflux symptoms. The prevalence of peptic ulcer disease has at the same time declined in step with a decrease in H. pylori infection. Many of the changes taking place mirror the Western experience of several decades ago. Astute observation of the epidemiology of emerging diseases combined with good scientific work will allow a clearer understanding of the key processes underlying these changes. With rapid modernization, lifestyle changes have been blamed for an increase in several diseases including gastroesophageal reflux disease, nonalcoholic fatty liver disease and colorectal cancer. A worrying trend has been the increase in obesity among Asians, which has been associated with an increase in metabolic diseases and various gastrointestinal cancers. Conversely, an improvement in living conditions has been closely linked to the decrease in GCA and H. pylori prevalence.

Erosive esophagitis in the Philippines: a comparison between two time periods

BACKGROUND

In Asia, the incidence of gastroesophageal reflux disease diagnosed through endoscopy has increased from 3-9% to 14-16% in the last decade. The aim of this study was to determine the prevalence of erosive esophagitis (EE) over a span of 10 years in a tertiary care facility in the Philippines.

METHODS

All patients diagnosed with EE from 1994 to 1997 (period A) and from 2000 to 2003 (period B) were included in the study. The modified Savary-Miller and Los Angeles classifications were used to grade EE for periods A and B, respectively.

RESULTS

A total of 15 981 upper endoscopies were evaluated for this study. There was no significant difference in the male: female ratio (period A 1.43:1 vs period B 1.25:1, P = 0.459) and in the mean age of patients with EE (period A 46.4 vs period B 47.5, P = 0.395). The prevalence of EE was significantly higher (P < 0.0001) in period B (6.3%) as compared to period A (2.9%). However, despite a higher prevalence, more patients had mild esophagitis in period B as compared to period A. Conversely, there were more patients with esophageal ulcers (18.6%vs 5.9%, P < 0.001), esophageal strictures (2.3%vs 0%, P = 0.003), and hiatal hernia (15.8%vs 7.5%, P = 0.001) in period A. The presence of concomitant Barrett's esophagus was not significantly different between the two time periods (period A 3.2%vs period B 5%, P = 0.367).

CONCLUSIONS

The prevalence of EE was higher in 2000-2003 than in 1994-1997, although the complications associated with the disease diminished. The prevalence of concomitant Barrett's esophagus remained stable.

Helicobacter pylori infection and related gastrointestinal diseases

Helicobacter pylori has been implicated in the pathogenesis of a number of digestive tract disorders, such as chronic active gastritis, peptic ulceration, gastric cancer, and mucosa-associated lymphoid tissue lymphoma. Disease outcome is dependent on many factors, including bacterial genotype, host physiology and genetics, and environmental factors such as diet. Researchers continue to explore the complexities of H. pylori infection, seeking to explain why some individuals have asymptomatic infection, whereas others experience clinical disease. The importance of treating H. pylori infection in patients with gastrointestinal problems has been confirmed in recent years, with clinical trials showing that cure of infection can prevent duodenal ulcer and, to a lesser extent, gastric ulcer recurrence; cure early stage mucosa-associated lymphoid tissue lymphoma; and reduce the chances of developing gastric cancer in high-risk individuals.