Changing pattern of peptic ulcer in India. An endoscopic study of 1,188 ulcer patients

Earlier studies have described a profile of peptic ulcer different in developing and developed countries. In a prospective endoscopic study in India over 5 years and 8 months involving 5,948 patients with upper gastrointestinal symptoms, we detected peptic ulcers in 1,188. There were 920 patients with duodenal ulcer (DU), 185 with gastric ulcer (GU), and 83 with combinations of the two. The male to female ratio was 4.2:1. About half the ulcers were in patients age greater than or equal to 40 years. Of the 223 (18.7%) patients with peptic ulcer complications, gastrointestinal bleeding was the most common (12.7%) and gastric outlet obstruction was less common (6.2%). Endoscopic evidence of duodenal bulb deformity was seen in 74.4% of DU patients. A comparison of these results with data from previous Indian studies suggests a changing trend of peptic ulcer with respect to age and sex distribution, the ratio between DU and GU, and complications of peptic ulcer. The profile of peptic ulcer in north India today is similar to that seen in Western countries four to five decades ago. We discuss possible factors responsible for this change.