Peptic ulcer disease incidence

The high incidence of peptic ulcer disease created great interest in the therapeutic potential of these H2-receptor antagonists when first discovered. Even though they are not the most efficacious agents available, their ability to reduce gastric acid secretion with very low toxicity has made them extremely popular and they have become OTC items. These drugs are discussed in more detail in Chapter 62. 

Circunstantial evidence directly implicating dopamine in the pathogenesis of duodenal ulcer in man is the unusual incidence of peptic ulcer disease in dopamine-deficient disorders. From purely descriptive clinical and epidemiologic studies we know that patients with Parkinson s disease, before the introduction of dopamine therapy, had an excess of ulcer disease (72). One report even comments on the curiosity that after initiation of L-DOPA administration the ulcer symptoms have virtually disappeared (72 ). On the other hand, less clearly, schizophrenia which is associated with dopamine excess and/or receptor hyperactivity is accompanied by virtual lack, or decreased prevalence, of peptic ulcer (73-76). Schizophrenia associated with ulcer disease has been viewed as a reportable curiosity in medical literature (75). At present, possibly because of the widespread therapeutic application of neuroleptics, the lack of peptic ulcer disease in schizophrenics is less striking than in the past. On the other hand, we recently observed in our autopsy series perforated duodenal ulcers in two schizophrenic patients who had been on large doses of haloperidol therapy (Szabo, unpublished observation). Thus, even in man, dopamine may indeed be implicated in the pathogenesis of duodenal ulcer disease. 

Gastrointestinal. Patients taking continuous steroid, especially in combination with a nonsteroidal antiinflammatory drug (NSAID), have an excess incidence of peptic ulcer and haemorrhage of about 1-2%. It is plainly unreasonable to seek to protect all such patients by routine prophylactic antiulcer therapy, i.e. to treat 98 patients unnecessarily in order to help two. But such therapy (proton pump inhibitor, histamine H -receptor blocker, sucralfate) is appropriate when ulcer is particularly likely, e.g. a patient with rheumatoid arthritis taking an NSAID, or for patients with a history of peptic ulcer disease. There is increased incidence of pancreatitis. 

Moderate nausea, diarrhea, or abdominal pain can occur in patients taking omeprazole (13). There is an increased incidence of the severe interstitial and atrophic forms of gastritis, associated with moderate hypergastrinemia and hjrperplasia of the argyrophil cells (1). This is not necessarily an adverse effect it could represent the natural history of chronic gastritis associated with peptic ulcer disease. 

Although the incidence of peptic ulcer disease has steadily declined in the United States since the turn of the twentieth century, approximately 500,000 new cases and 4 million recurrences annually are reported. In 1990, it was estimated that the annual direct cost related to diagnosis and treatment of peptic ulcer disease in the United States was between 3 and 4 billion dollars, compared to the 2.5 million dollars estimated in 1975. 

H. Rautelin, B. Blomberg, H. Fredlund, G. Jarnerot, D. Danielsson, Incidence of Helicobacter pylori strains activating neutrophils in patients with peptic ulcer disease. Gut, 1993, 34, 599-603. 

Clearly, the addictive power of cigarettes is directly related to their nicotine content. It is not known to what extent nicotine per se contributes to the other well-documented adverse effects of chronic tobacco use. It appears highly probable that nicotine contributes to the increased risk of vascular disease and sudden coronary death associated with smoking. Also, nicotine probably contributes to the high incidence of ulcer recurrences in smokers with peptic ulcer. 

The most common sites of GI injmy are the gastric and duodenal mucosae." The incidence of gastric ulcers with NSAID use is approximately 11% to 13%, and that for duodenal ulcers is 7% to 10%. Serious GI complications associated with NSAIDs, including perforations, gastric outlet obstruction, and GI bleeding, occur in 1.5% to 4% of patients per year. NSAIDs are so widely used that these small percentages translate into substantial morbidity and mortality. " Moreover, the risk increases to 9% per year for patients with the risk factors of advanced age, history of peptic ulcer or GI bleeding, or cardiovascular disease. Consequently, about 16,500 deaths are associated annually with NSAID use in rheumatoid arthritis or OA patients. 

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