Epidemiology of Peptic Ulcer Disease: Endoscopic Results of ... - IAGH

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Barazandeh et al. 95 As for microbiological studies, high prevalence of H.pylori infection (73.3%/10130 individuals) has been demonstrated in a Chinese study. 16 H.pylori infection as a major cause of PUD, 18 was found in 73-100% of the patients with duodenal ulcers and 65-100% of patients with gastric ulcer. 19-23 During a 10-year study in Korea, Jang et al. 24 found out that the prevalence of PUD and mainly that of duodenal ulcers had a decreasing trend. The incidence of duodenal ulcers in western population is steadily decreasing due to better hygiene and sanitation and administration of proper regimes for H.pylori eradication. 25 In the present study, we found that nearly all individuals with PUD (93.9% for gastric ulcer and 100% for duodenal ulcer) were infected with H.pylori. The high prevalence of H.pylori infection in PUD was in accordance with Chinese endoscopic studies (92.6%), 13-16 and in contrast with European studies (33.9%, 57.7%). 4,6 It was also possible that the Chinese population may have similar prevalence of ulcerogenic strains of H. pylori to Iran. In contrast to the result of the European population-based studies, 4,6 and in accord with Li et al. 16 we found no association between PUD and reflux esophagitis, although reflux esophagitis was numerically more common in individuals with PUD. Frank et al. evaluated the prevalence of upper gastrointestinal symptoms and its relation to health care utilization and quality of care. They found that individuals suffering from GERD and ulcer had more physician visits for their symptoms. 26 Gastrointestinal reflux disease appears to be increasing, 27 according to several epidemiological symptoms, particularly due to related life style factors such as diet and obesity. 28,29 Smoking, aspirin consumption, and obesity were risk factors for 4.1% prevalence of PUD in northern Sweden. 4 Although we did not evaluate the care utilization of the patients with PUD, there was no association between heart burn and GERD. While among 50-60% of our studied PUD patients with heart burn, association between heart burn (60%) and GERD was demonstrated. Based on the multivariate analysis, H.Pylori infection, current smoking, and chronic NSAID intake were the main environmental risk factors associated with gastric ulcer. On the other hand, for duodenal ulcer, H.Pylori infection, current smoking, male gender, and urban residence were the main risk factors. Generally speaking, our results might actually reflect the association of high prevalence of H.pylori infection with PUD in Iran. Moreover, this strong association may be an explanation for extremely high prevalence of atrophic gastritis in gastric ulcers. Concluding, there is a paradox between the prevalence of PUD and H. pylori infection in our study findings in comparison with those of Asian and European studies. We know that the diet of Iranians contains high amounts of saturated fat and protein, which is more similar to Europeans while on the other hand, the current level of hygiene and sanitation in regions in our study is mostly identical to those in Asian studies. In short, it seems that the first explains why our PUD prevalence is close to Europeans and the latter explains why the pattern of H.Pylori infection mimics Asians. If this hypothesis is assumed to be accurate, it confirms that PUD is a multi-factorial disorder and multidimensional health strategies are required to overcome it. Conflict of interest The authors declare no conflict of interest related to this work. References 1. 2. 3. 4. Vakil N, Dent J , Jones R Lind T, Junghard O. The accuracy and predictors of a clinical diagnosis of dyspepsia or peptic ulcer disease by gastroenterologists and family practitioners. Gastroenterology 2008;134:A629. Lydeard S, Jones R. Factors affecting the decision to consult with dyspepsia: comparison of consulters and non-consulters. J R Coll Gen Pract 1989;39:495–8. Howell S, Talley NJ. Does fear of serious disease predict consulting behaviour amongst patients with dyspepsia in general practice Eur J Gastroenterol Hepatol 1999;11:881–6. Aro P, Storskrubb T, Ronkainen J, Bolling-Sternevald E, Engstrand L, Vieth M,et al. Peptic ulcer disease in a general adult population: the Kalixanda study: a random population-based study .Am J Epidemiol 2006;163:1025 – 34. Middle East Journal of Digestive Diseases/ Vol.4/ No.2/ April 2012
96 Epidemiology of Peptic Ulcer Disease 5. 6. 7. 8. 9. 10. 11. 12. Zagari RM, Fuccio L, Wallander MA, Johansson S, Fiocca R, Casanova S, et al. Gastro-oesophageal reflux symptoms, oesophagitis and Barrett’s oesophagus in the general population: Loiano-Monghidorostudy . Gut 2008;57:1354 – 9. Zagari RM, Law GR, Fuccio L, Pozzato P, Forman D, Bazzoli F. Dyspeptic symptoms and endoscopic findings in the community: the Loiano-Monghidoro study. Am J Gastroenterol 2010;105;565 – 71. Bian ZQ ,Hua ZL , Zheng DQ . Endoscopy analysis and epidemiology analysis of peptic ulcer . Chin J Digest 2008;28;460 – 3. Talley NJ, Fung LH, Gilligan IJ, McNeil D, Piper DW. Association of anxiety,neuroticism, and depression with dyspepsia of unknown cause. A case-control study. Gastroenterology 1986;90:886–92. Sonnenberg A, Everhart JE. Health impact of peptic ulcer in the United States. Am J Gastroenterol 1997; 92:614-20. Nadim A, Noorai M. Cancers. In: Azizi F, Hatami H, Janghorbani M, eds. Epidemiology and control of common diseases in Iran, 1st ed. Tehran: Eshtiagh, 2000:216–7. Naghavi M. Death report from 10 provinces in Iran, 1st ed. Tehran: Ministry of Health, 2000: 384. Sadjadi AR, Malekzadeh R, Derakhshan MH, Sepehr A, Nouraie M, Sotoudeh M, et al. Cancer occurrence in Ardabil: results of a population based cancer registry from Iran. Int J Cancer 2003;107:113–8. 21. 22. 23. 24. 25. 26. 27. ulcer. Am J Gastroenterol 1991;86:1154–7. Kuipers EJ, Thijs JC, Festen HP. The prevalence of Helicobacter pylori in peptic ulcer disease. Aliment Pharmacol Ther 1995;9:59–69. Tsuji H, Kohli Y, Fukumitsu S, Morita K, Kaneko H, Ohkawara T, et al. Helicobacter pylori negative gastric and duodenal ulcers. J Gastroenterol 1999;34:455–60. Meucci G, Di Battista R, Abbiati C, Benassi R, Bierti L, Bortoli A, et al. Prevalence and risk factors of Helicobacter pylori-negative peptic ulcer: a multicenter study. J Clin Gastroenterol 2000;31:42–7. Jang HJ, Choi MH, Shin WG, Kim KH, Chung YW, Kim KO, et al. Has peptic ulcer disease changed during the past ten years in Korea A prospective multi-center study. Dig Dis Sci 2008;53:1527-31. Groenen MJ, Kuipers EJ, Hansen BE, Ouwendijk RJ. Incidence of duodenal ulcers and gastric ulcers in a Western population: back to where it started. Can J Gastroenterol 2009;23:604-8. Frank L, Kleinman L, Ganoczy D, McQuaid K, Sloan S, Eggleston A, et al. Upper gastrointestinal symptoms in North America: prevalence and relationship to healthcare utilization and quality of life. Dig Dis Sci 2000;45:809-18. El-Serag HB. Time trends of gastroesophageal reflux disease: a systematic review. Clin Gastroenterol Hepatol 2007;5:17–26. 13. 14. Xia B, Xia HH, Ma CW ,Wong KW, Fung FM, Hui CK, et al. Trends in the prevalence of peptic ulcer disease and Helicobacter pylori infection in family physician-referred uninvestigated dyspeptic patients in Hong Kong. Aliment Pharmacol Ther 2005;22:243 – 9. Wong SN, Sollano JD, Chan MM , Carpio RE, Tady CS, Ismael AE,, et al. Changing trends in peptic ulcer prevalence in a tertiary care setting in the Philippines: a seven-year study. J Gastroenterol Hepatol 2005;20:628 – 32. 28. 29. Dent J, El-Serag HB, Wallander MA, Johansson S. Epidemiology of gastro–oesophageal reflux disease: a systematic review. Gut 2005;54:710–7. Moayyedi P, Talley NJ. Gastro-oesophageal reflux disease. Lancet 2006;367:2086–100. 15. Dong WG, Cheng CS, Liu SP, Yu JP.Epidemiology of peptic ulcer disease in Wuhan area of China from 1997 to 2002. World J Gastroenterol 2004;10:3377 – 9. 16. Li Z, Zou D, Ma X, Chen J, Shi X, Gong Y, et al. Epidemiology of peptic ulcer disease: endoscopic results of the systematic investigation of gastrointestinal disease in China. Am J Gastroenterol 2010;105:2570-7. 17. Sung JJ, Kuipers EJ, El-Serag HB. Systematic review: the global incidence and prevalence of peptic ulcer disease. Aliment Pharmacol Ther 2009;29:938-46. 18. Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1984;1:1311–5. 19. Ciociola AA, McSorley DJ, Turner K, Sykes D, Palmer JB..Helicobacter pylori infection rates in duodenal ulcer patients in the United States may be lower than previously estimated. Am J Gastroenterol 1999;94:1834–40. 20. Borody TJ, George LL, Brandl S, Andrews P, Ostapowicz N, Hyland L, et al. Helicobacter pylori-negative duodenal Middle East Journal of Digestive Diseases/ Vol.4/ No.2/ April 2012
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