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Comparative Study
. 1998 Sep;43(3):327-33.
doi: 10.1136/gut.43.3.327.

Opposing time trends of peptic ulcer and reflux disease

H B el-Serag  1 , A Sonnenberg
Affiliations
Comparative Study

Opposing time trends of peptic ulcer and reflux disease

H B el-Serag et al. Gut. 1998 Sep.

Abstract

Background: Gastritis associated hypochlorhydria may be protective against gastro-oesophageal reflux disease. It was hypothesised that the historic decline in Helicobacter pylori infection resulted in a decline in peptic ulcer and a concomitant risk in reflux disease.

Aims: To study the time trends of peptic ulcer and reflux disease.

Methods: Hospitalisation rates were analysed using the computerised database of the US Department of Veterans Affairs from 1970 until 1995. Death rates were calculated from the Vital Statistics of the United States.

Results: From 1970 to 1995, hospitalisation rates for gastric and duodenal ulcer, as well as gastric cancer fell, while the hospitalisation rates for gastro-oesophageal reflux disease and those for oesophageal adenocarcinoma rose significantly. Similar time trends were observed with respect to the death rates. There were notable ethnic differences. White subjects incurred higher rates of reflux disease and oesophageal adenocarcinoma and lower rates of gastric ulcer or cancer compared with non-whites.

Conclusions: The ethnic variations and the opposing time trends of gastroduodenal versus oesophageal disease are consistent with the hypothesis that the declining infection rates of H pylori in the general population have led to a rise in the occurrence of gastro-oesophageal reflux disease and associated oesophageal adenocarcinoma.

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Figures

Figure 1
Figure 1
Time trends of hospitalisation for gastric cancer of the corpus or antrum and oesophageal adenocarcinoma/cancer of the cardia. Data points represent the average of consecutive time periods as shown on the x axis.
Figure 2
Figure 2
Time trends of hospitalisation for gastric ulcer, duodenal ulcer, and gastro-oesophageal reflux disease. Data points represent the average of consecutive time periods as shown on the x axis.
Figure 3
Figure 3
Time trends of death rates from gastric cancer of the corpus or antrum and oesophageal adenocarcinoma/cancer of the cardia. Data points represent the average of consecutive time periods as shown on the x axis.
Figure 4
Figure 4
Time trends of death rates from gastric ulcer, duodenal ulcer, and erosive oesophagitis. Data points represent the average of consecutive time periods as shown on the x axis.
See this image and copyright information in PMC

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