Objective-To determine the incidence and age distribution of peptic ulcer disease in adults in Gothenburg.Design-Retrospective study of patients with symptoms over one year.Setting-All gastroenterology and x ray departments.Patients-Any patient found to have an active ulcer crater during 1985.Main outcome measures-Sex, age, past history of gastrointestinal ulcers, and smoking habit.Results-In 1985, 1402 peptic ulcers were diagnosed in 1137 adults. Over half (403; 54%) of the ulcers in men and 393 (60%) ulcers in women were in patients aged over 60. All types of ulcer showed increasing incidence with age. The sex ratio of patients aged 40-50 with peptic ulcers was 1:1. Nearly half (109; 48%) of ulcers diagnosed for the first time in men and 129 (57%) of such ulcers in women were in patients aged over 60. Elderly men and women were also more likely to develop haemorrhage.Conclusions-In Gothenburg there is a surprisingly high incidence of peptic ulcer disease, which increases considerably with age, possibly explained by the availability of modem diagnostic techniques as 1121 (80%) ulcers had been diagnosed by gastroscopy. Compared with earlier studies there was no difference in the incidence between men and women aged 40-50. IntroductionDuring the past 20 years the death rate and rate of

Previous studies have shown that pancreatic polypeptide (PP) secretion is regulated by efferent, vagal stimulation. In the present study the afferent part of a vagovagal pathway has been investigated in two different ways: (I) Graded fundic distention: in 8 patients with duodenal ulcer ballon distention with 150 ml of the fundus and the body of the stomach increased PP concentrations in plasma from 19 (17–26) to 41 (35–48) pmol/l, median and interquartile range. Distention by 300 and 600 ml did not further increase PP concentrations. After denervation of the fundus by proximal gastric vagotomy, no increase in PP levels was observed during distention with 50 and 300 ml whereas distention by 600 ml was followed by a small increase. (II) Graded antral distention: balloon distention with 50, 100 and 150 ml of the antrum increased plasma PP concentrations in 7 healthy subjects and 14 duodenal ulcer patients. Maximal PP response was achieved by distention with 100 ml, healthy subjects: from 14 (12–23) to 40 (26–44) pmol/l, and duodenal ulcer patients: from 25 (13–38) to 47 (22–63) pmol/l, median and interquartile range. It is concluded that a gastropancreatic reflex stimulating PP secretion through a long vagovagal pathway is present in man, and that this mechanism probably is involved in the initial PP response during a meal.

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The prevalences of peptic ulcer and smoking were assessed by a questionnaire sent to 6726 residents of Gothenburg selected at random from the birth cohorts 1945, -35, -25, -15, and -05. The point prevalence of peptic ulcer was in all age groups significantly higher among smokers than among non-smokers. The incidence of peptic ulcer in 1985 was deduced from records of ulcers detected at gastroscopy and/or radiography and/or emergency surgery (n = 1402). Smoking habits and previous episodes of peptic ulcer disease were evaluated. The estimated risk of getting peptic ulcer was significantly higher among smokers in all age groups and of both sexes than among non-smokers. Among non-smokers the risk of getting peptic ulcer was significantly higher in men than in women, whereas the risk among smokers showed no sex difference. In people aged 35-84 years, 25.4% (n = 101) of ulcers diagnosed for the first time and 42.0% (n = 246) of relapsing ulcers were estimated to be caused by smoking. The number of smoking years, however, could not be shown to influence the risk of peptic ulcer.