Peptic ulcer disease in the 1990s: an Asian perspective

Peptic ulcer disease is still a common disease in many parts of Asia, although it is less common today than it was 2-3 decades ago. Contrary to this general trend, peptic ulcers are on the rise in the elderly, particularly elderly females. Two important factors that could explain the observed changes in the trends of peptic ulcer disease are: Helicobacter pylori and NSAID. The seroprevalence of H. pylori, determined in three previous studies, would appear to have decreased over the last few decades, while NSAID and aspirin are used increasingly for arthritis, cerebrovascular disease and coronary artery disease. The major complication of peptic ulcer disease is gastrointestinal haemorrhage and in the 1990s endoscopic haemostatic therapy has replaced surgery as the treatment of choice. Treatment of peptic ulcer disease caused by H. pylori is directed at eradication of H. pylori itself; four classes of drug regimens are currently available for this. Antibiotic resistance, particularly metronidazole resistance, is an important factor that determines the outcome of therapy. Metronidazole resistance is reported to be present in 50% of all strains of H. pylori in Hong Kong and Singapore, and is present in 80-90% of all strains in India. Eradication rates in Asia, may for this reason, differ from those in the West, if the regimen contains metronidazole. Treatment of NSAID-associated ulcer consists of discontinuation of NSAID, if possible, and administration of anti-secretory drugs such as H2 blockers, proton pump inhibitors or mucosal protective agents. Co-prescription with misoprostol has been shown to reduce the risk of NSAID-induced ulcer. New NSAID or NO NSAID are being developed with few gastrointestinal side effects.