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Differences in peptic ulcer between the East and the West
1Concord Hospital, Ambulatory Care Endoscopy Unit, Level 1 West, Hospital Road, Concord, Sydney NSW 2139, Australia. rupertleong@hotmail.com
Gastroenterology Clinics of North America
|May 19, 2009
Summary
Peptic ulcer disease (PUD) affects global populations, with epidemiology complicated by data limitations and varying risk factors like H pylori and NSAID use. Idiopathic PUD is a growing concern, impacting treatment strategies.
Area of Science:
- Gastroenterology
- Epidemiology
- Pharmacology
Background:
- Peptic ulcer disease (PUD) presents a significant global health challenge, affecting both Eastern and Western populations, though regional variations in prevalence exist.
- Epidemiological studies of PUD are hindered by a lack of comprehensive population-based data, invasive diagnostic methods, and unequal access to healthcare facilities.
- Key risk factors for PUD include Helicobacter pylori (H pylori) infection, with prevalence varying by sanitation, and widespread, increasing use of non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin, particularly for cardiovascular prophylaxis.
Purpose of the Study:
- To explore the complex epidemiology of peptic ulcer disease (PUD) across diverse geographical regions.
- To examine the influence of H pylori infection, NSAID/aspirin use, and emerging idiopathic PUD on disease patterns.
- To discuss factors affecting treatment efficacy, including pharmacogenetics and H pylori resistance to proton pump inhibitors (PPIs).
Main Methods:
- Review of existing epidemiological data on peptic ulcer disease (PUD) prevalence.
- Analysis of the impact of H pylori infection rates, influenced by sanitation.
- Assessment of NSAID and aspirin usage trends and their association with PUD.
Main Results:
- Direct comparisons of PUD epidemiology between East and West are challenging due to data limitations.
- Prevalence of H pylori varies significantly based on local sanitation conditions.
- Idiopathic PUD is an increasing proportion of cases in both regions, especially where H pylori infection is declining.
Conclusions:
- Peptic ulcer disease (PUD) epidemiology is multifactorial, influenced by H pylori, NSAIDs, and potentially pharmacogenetics.
- The rise of idiopathic PUD necessitates a re-evaluation of diagnostic and treatment strategies.
- Treatment success for PUD, particularly H pylori eradication, is affected by genetic factors influencing PPI efficacy and local antibiotic resistance patterns.
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