Epidemiological aspects of peptic ulcer disease on the Faroe Islands. An interim report

Systematic review of peptic ulcer disease incidence rates: do studies without validation provide reliable estimates?

PURPOSE

Incidence rate (IR) estimates for peptic ulcer disease (PUD) vary widely among studies. We conducted a systematic review to quantify and examine the discrepancies.

METHODS

Of 4780 articles identified from PubMed and EMBASE databases, 31 published in the last three decades that had reported IRs of PUD in the general population were included. Random effects meta-analysis and meta-regression were performed to calculate pooled estimates and to identify sources of heterogeneity.

RESULTS

The pooled IR estimate per 1000 person-years was 0.90 (95% confidence interval: 0.78-1.04) for uncomplicated PUD, 0.57 (0.49-0.65) for peptic ulcer bleeding, 0.10 (0.08-0.13) for gastrointestinal perforations, and 3.18 (2.05-4.92) for nonspecific PUD. Within specific outcomes definitions, IR estimates were significantly lower in studies with restriction to hospitalized cases, case validation, and case ascertainment directly from hospital or clinical sources versus computerized health care databases. Younger age, female sex, and later calendar time were also associated with lower PUD incidence.

CONCLUSIONS

We found that the IR of uncomplicated PUD was in the order of one case per 1000 person-years in the general population, and that the IR of peptic ulcer complications was around 0.7 cases per 1000 person-years. Comparisons of IR estimates among studies need to take into account disease definition and other study characteristics, particularly whether outcome validation was performed in computerized claims. The use of claims to identify PUD cases might overestimate the IR by around 45%.

Prevalence and incidence of peptic ulcer disease in a Danish County--a prospective cohort study

Peptic ulcer prevalence and five year incidence were assessed in a sex and age stratified population sample of 3608 Danish subjects aged 30-60 years. Statements of peptic ulcer disease obtained from questionnaires were scrutinised by reviewing medical records. Life time ulcer prevalence (95% confidence intervals) was 5.6 (4.9-6.4) per cent. Male to female prevalence ratio was 2.2:1, and duodenal to gastric ulcer prevalence ratio was 3.8:1. Thirty two participants with no previous history of peptic ulceration developed an ulcer within the observation period resulting in a five year ulcer incidence of 11.3 (7.4-15.2) per 1000 persons at risk with no demonstrable sex difference. The prevalence of duodenal ulcer has declined in Denmark whereas gastric ulcer prevalence in men has increased slightly. A decline in male duodenal ulcer incidence has probably contributed to the low male to female ulcer incidence ratio, implying that women today incur the same risk of developing an ulcer as men. If such trends continue, they will bring about a new era in ulcer epidemiology characterised by equal incidence in men and women and an even distribution of lesions in the stomach and duodenum.

Incidence of peptic ulcer disease in Gothenburg, 1985

OBJECTIVE

To determine the incidence and age distribution of peptic ulcer disease in adults in Gothenburg.

DESIGN

Retrospective study of patients with symptoms over one year.

SETTING

All gastroenterology and x ray departments.

PATIENTS

Any patient found to have an active ulcer crater during 1985.

MAIN OUTCOME MEASURES

Sex, age, past history of gastrointestinal ulcers, and smoking habit.

RESULTS

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.

CONCLUSIONS

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.

Changed profile of peptic ulcer disease in hospital patients during 1969-1984 in Finland

The annual number of hospital discharges for peptic ulcer decreased in Finland from 1969 to 1974, mainly because of a smaller number of men with uncomplicated peptic ulcer disease. After the mid-1970s the number of hospital admissions remained stable, whereas the number of elderly patients increased. From 1979 to 1984 the number of hospitalizations for perforated ulcers remained stable, whereas those for ulcer haemorrhages increased, the increase being most marked in the older age groups. The age-specific mortality from peptic ulcer remained stable from 1969 to 1984 and rose thereafter among old patients. The risk of death from peptic ulcer was about 10-fold higher in patients over 75 years old than in younger age groups, and about half of the deaths caused by peptic ulcer occurred in patients over 75 years old. The men to women ratio among hospitalized patients decreased from 3.5 in the late 1960s to 2.1 in the 1980s, and the gastric ulcer to duodenal ulcer ratio was about 1.1 throughout the observation period.