Trends in the prevalence of peptic ulcer disease and Helicobacter pylori infection in family physician‐referred uninvestigated dyspeptic patients in Hong Kong

Abstract

Summary Background: Peptic ulcer disease is mainly caused by Helicobacter pylori infection and the use of non‐steroidal anti‐inflammatory drugs. Aim: To investigate the trends in the prevalence of peptic ulcer disease, H. pylori infection and non‐steroidal anti‐inflammatory drug use in uninvestigated dyspeptic patients over recent years in Hong Kong. Methods: Data from consecutive patients with uninvestigated dyspeptic symptoms referred by family physicians for open access upper endoscopy during 1997 and 2003 were analysed in relation to peptic ulcer disease, H. pylori infection and non‐steroidal anti‐inflammatory drug use. Results: Among 2700 patients included, 405 (15%) had peptic ulcer disease and 14 (0.5%) had gastric cancer. There was a reduced trend from 1997 to 2003 in the prevalence of peptic ulcer disease (17, 20, 14, 16, 13, 14 and 14%, respectively, χ2 = 5.80, P = 0.016) (mainly because of decrease in duodenal ulcers), H. pylori infection (44, 50, 49, 44, 40, 40, 36 and 43%, respectively, χ2 = 13.55, P < 0.001) and non‐steroidal anti‐inflammatory drug use (13, 5, 5, 6, 3, 4, 4 and 5% respectively, χ2 = 13.61, P < 0.001). The prevalence of peptic ulcer disease, H. pylori infection and non‐steroidal anti‐inflammatory drug use between 2001 and 2003 were significantly lower than that between 1997 and 2000 (17% vs. 13%, OR = 0.78, 95% CI: 0.63–0.96, P = 0.020 for peptic ulcer disease; 47% vs. 39%, OR =0.72, 95% CI: 0.60–0.86, P < 0.001 for H. pylori infection; and 6% vs. 4%, OR = 0.56, 95% CI: 0.39–0.82, P = 0.002 for non‐steroidal anti‐inflammatory drug use). H. pylori infection was associated with both duodenal ulcer (OR = 15.87, 95% CI: 10.60–23.76, P < 0.001) and gastric ulcer (OR = 3.12, 95% CI: 2.15–4.53, P < 0.001) whereas non‐steroidal anti‐inflammatory drug use was only associated with gastric ulcer (OR = 2.97, 95% CI: 1.70–5.20, P < 0.001). Conclusions: The prevalence of peptic ulcer disease, mainly duodenal ulcers, was reduced in association with a decreasing trend in the prevalence of H. pylori infection and non‐steroidal anti‐inflammatory drug use from 1997 to 2003.

Decrease in prevalence of Helicobacter pylori infection during a 10-year period in Brazilian children

“…In the Philippines, from 1996 to 2002 there was a reduction of duodenal ulcer prevalence from 15.83% to 7.02% in adults, from 20.05% to 14.7% for gastric ulcer among patients with endoscopy while, among patients with peptic ulcer the proportion of infected patients decreased from 71.9% to 34.6% (20) . A study from Hong Kong reached similar results, but with the additional factor of less consumption of anti-inflammatory drugs in the period (21) . A seroprevalence study in Taiwan did not reproduce the trend on comparing its data with another study of 1989.…”

Upper gastrointestinal endoscopic findings and prevalence of Helicobacter pylori infection among adult patients with dyspepsia in northern Tanzania

“…This lower prevalence of the infection is probably due to improvements in sanitation and water supply over the past decades as well as increased awareness and the widespread use of antibiotic therapy. Despite several reports suggesting decreasing prevalence of the infection (Rothenbacher & Brenner, 2003;Xia et al, 2005;Tkachenko et al, 2007;Kate et al, 2009) clinicians working in developing countries should still consider H. pylori as important etiologic agent.…”

“…H. pylori infection is associated with various upper gastrointestinal pathologies such gastritis, peptic ulcers and gastric cancer (Graham, 1994;Blaser, 1995;Go, 2002;Marshall & Winsdor, 2005). Because of the strong association between this gram negative bacterium infection and gastrointestinal diseases and its high prevalence rate in developing countries (Suerbaum & Michetti 2002;Frenck & Clemens, 2003;Kazuo et al, 2004;Xia et al, 2005;Tkachenko et al, 2007;Kate et al, 2009)., H. pylori infection is among the leading gastroenterological public health problems in developing countries (Kate et al, 2009).…”

Adenocarcinoma of the esophagogastric junction: Do we see more or less?

“…However, less than 30% of needle-stick injuries were reported to appropriate authorities. [7][8][9][10] In 1991, the World Health Organization (WHO) recommended that HBV vaccination should be included in the mass immunization program of all countries by 1997, and, to date, 147 countries have implemented it. 11 Among Asia-Pacific countries, India, Philippines and Cambodia have yet to implement HBV vaccination programs, 6 and the HBV disease burden in these countries remains unchanged.…”

“…6,7 However, this phenomenon has not been observed in other Asian countries and zones, including Hong Kong, despite the fact that the local prevalence of H. pylori infection is also decreasing 8 and that of gastroesophageal reflux disease is similarly increasing. 9 The ratio of esophageal adenocarcinoma versus squamous cell carcinoma has not increased in last two decades according to a Taiwanese study. 10 In Hong Kong, the incidence of esophageal adenocarcinoma declined from 1.10/ 100 000 in 1984-1988 to 0.34/100 000 in 1998-2003.…”