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Is the prevalence of idiopathic ulcers really on the increase?

Nature Clinical Practice Gastroenterology & Hepatology volume 4, pages 176–177 (2007)Cite this article

The epidemiology of peptic ulcer disease has changed in the past decade because of the huge effort made to eradicate Helicobacter pylori (H. pylori) infection, which is the most important cause of peptic ulcers. As the prevalence of H. pylori infection has declined, the proportion (and actual numbers) of patients with H. pylori-negative idiopathic ulcers, and of ulcers attributed to the use of aspirin, have risen.

In North America, there is good evidence that 20–40% of peptic ulcers are not associated with H. pylori infection, or the use of NSAIDs. Jyotheeswaran et al. reported that, after excluding NSAID users, only 61% of patients with peptic ulcers in their cohort had H. pylori infection.1 In a pooled analysis of six clinical trials that included 2,900 patients, 27% of duodenal ulcers were found not to be associated with H. pylori or NSAID use.2 A meta-analysis of seven, double-blind, randomized trials in North America found that 20% of patients with H. pylori-associated ulcers had ulcer recurrence within 6 months, despite successful H. pylori eradication and no reported NSAID use.3 On the other side of the globe, the reported frequencies of non-H. pylori ulcers and non-NSAID ulcers are low in Asian populations—only 1.3% in Japan4 and 4.1% in Hong Kong.5

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Authors and Affiliations

  1. Chairman of the Department of Medicine & Therapeutics, DKL Chow is a gastroenterology trainee in the Institute of Digestive Disease at the Chinese University of Hong Kong. JJY Sung is a Professor of Medicine, and Director of the Institute of Digestive Disease at the Chinese University of Hong Kong. He is also Director of the Stanley Ho Center for Emerging Infectious Diseases, Hong Kong Special Administrative Region, China.,

    Dorothy KL Chow & Joseph JY Sung

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  1. Dorothy KL Chow
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  2. Joseph JY Sung
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Correspondence to Joseph JY Sung.

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The authors declare no competing financial interests.

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Chow, D., Sung, J. Is the prevalence of idiopathic ulcers really on the increase?. Nat Rev Gastroenterol Hepatol 4, 176–177 (2007). https://doi.org/10.1038/ncpgasthep0769

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