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Fekadu S, Engiso H, Seyfe S, Iizasa H, Godebo A, Deyno S, Yoshiyama H. Effectiveness of eradication therapy for Helicobacter pylori infection in Africa: a systematic review and meta-analysis. BMC Gastroenterol 2023; 23:55. [PMID: 36882697 PMCID: PMC9990047 DOI: 10.1186/s12876-023-02707-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/28/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND The effectiveness of Helicobacter pylori (H. pylori) eradication depends on the treatment protocol. This study investigates the H. pylori eradication rate in Africa using the best available evidence from databases. METHODS Databases were searched and results were pooled together. Heterogeneity between studies was assessed using I2 test statistics. Stata version 13 software was employed to compute the pooled eradication rate. In the subgroup analysis comparison, the finding is considered significant when the confidence intervals did not overlap. RESULTS Twenty-two studies from 9 African countries with a total population of 2,163 were included in this study. The pooled eradication rate of H. pylori was 79% (95% CI: 75%-82%), heterogeneity (I2 = 93.02%). In the subgroup analysis by study design, a higher eradication rate was reported from observational studies (85%, 95% CI: 79%-90%), compared to randomized control trials (77%, 95% CI: 73%-82%); by the duration of therapy, higher eradication rate was reported in 10-days regimen (88%, 95% CI: 84%-92%), compared to 7-days regimen (66%, 95% CI: 55%-77%); by country, the highest eradication rate was found in Ethiopia (90%; 95% CI: 87%-93%) and the lowest eradication rate was reported in Ivory Coast (22.3%; 95% CI:15%-29%); by type of H. pylori test, the highest eradication rate was reported when rapid urease test coupled with histology (88%, 95% CI: 77%-96%), and the lowest eradication rate was reported with histology alone (22.3%; 95% CI:15%-29%). Significant heterogeneity was observed with pooled prevalence (I2 = 93.02%, P < 0.000). CONCLUSIONS In Africa, the first-line therapy showed a variable eradication rate for H. pylori. This study demonstrates the necessity to optimize current H. pylori treatment regimens in each country, taking into account the antibiotic susceptibility. Future RCT studies with standardized regimens are warranted.
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Affiliation(s)
- Sintayehu Fekadu
- School of Laboratory Sciences, College of Medicine and Health Sciences, Hawassa University, P. O. Box 1560, Hawassa, Ethiopia.
| | - Hizkel Engiso
- School of Pharmacy, College of Medicine and Health Sciences, Hawassa University, P. O. Box 1560, Hawassa, Ethiopia
| | - Sisay Seyfe
- Department of Biochemistry, College of Medicine and Health Sciences, Hawassa University, P. O. Box 1560, Hawassa, Ethiopia
| | - Hisashi Iizasa
- Department of Microbiology, Faculty of Medicine, Shimane University, Shimane, Japan
| | - Ashebir Godebo
- Department of Soil Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Serawit Deyno
- School of Pharmacy, College of Medicine and Health Sciences, Hawassa University, P. O. Box 1560, Hawassa, Ethiopia
| | - Hironori Yoshiyama
- Department of Microbiology, Faculty of Medicine, Shimane University, Shimane, Japan
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Adachi K, Ishihara S, Hashimoto T, Hirakawa K, Niigaki M, Takashima T, Kaji T, Kawamura A, Sato H, Okuyama T, Watanabe M, Kinoshita Y. Efficacy of sucralfate for Helicobacter pylori eradication triple therapy in comparison with a lansoprazole-based regimen. Aliment Pharmacol Ther 2000; 14:919-22. [PMID: 10886048 DOI: 10.1046/j.1365-2036.2000.00791.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sucralfate has an inhibitory action against Helicobacter pylori and enhances the anti-H. pylori activity of antimicrobials. AIM To evaluate the efficacy and safety of sucralfate-based eradication therapy for H. pylori infection, compared with that based on lansoprazole, in a randomized multicentre study. SUBJECTS AND METHODS The subjects were 150 H. pylori-positive patients. They were randomly assigned to one of two regimens for 2 weeks: sucralfate 1 g t.d.s., amoxycillin 500 mg t.d.s., and clarithromycin 400 mg b.d. (SAC regimen: 75 patients); or lansoprazole 30 mg o.m. with the same antimicrobial medications (LAC regimen: 75 patients). Cure of infection was assessed by a 13C urea breath test 1 month after completion of treatment. RESULTS Eight patients (four in the SAC group and four in LAC group) could not continue therapy because of severe diarrhoea, and three did not take the 13C urea breath test after therapy. Cure rates for intention-to-treat, all-patients-treated, and per protocol analysis in the SAC group were 80%, 83%, and 88%, respectively, and those in the LAC group were 87%, 87%, and 92%, respectively. There were no significant differences in cure rate or adverse effects between the two regimens. CONCLUSION Sucralfate in combination with amoxycillin and clarithromycin is as effective as lansoprazole-based eradication therapy for H. pylori.
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Affiliation(s)
- K Adachi
- Department of Internal Medicine II, Shimane Medical University, Izumo, Japan.
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Happonen I, Linden J, Westermarck E. Effect of triple therapy on eradication of canine gastric helicobacters and gastric disease. J Small Anim Pract 2000; 41:1-6. [PMID: 10713975 DOI: 10.1111/j.1748-5827.2000.tb03127.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nine helicobacter-positive pet dogs with upper gastrointestinal signs were studied to evaluate the effect of a triple therapy, normally applied to humans for the eradication of gastric helicobacters, on clinical signs and gastric histology, as well as the recurrence of helicobacters after eradication in an extended follow-up in four dogs. Endoscopy was performed at entry to the study and repeated after eradication therapies and additional treatments. If the triple therapy (amoxycillin, metronidazole and bismuth subcitrate) failed, tetracycline and omeprazole were prescribed. Additional therapies were instituted if clinical signs persisted after eradication therapies. Helicobacter status was verified from gastric biopsy specimens by the urease test and histological examination, and in a few dogs also by brush cytology. Triple therapy eradicated gastric helicobacters in 7/9 dogs; gastric helicobacters were also eradicated in one dog treated with tetracycline and omeprazole. Eradication of helicobacters resulted in significant improvement, but not total resolution, of clinical signs. Subsequent additional therapies resulted in further alleviation of clinical signs. Neither triple therapy nor additional therapies had a significant effect on gastric histological changes. Gastric helicobacters recurred in 4/4 dogs within three years of the eradication treatment. Because canine gastric helicobacters alone were not definitively shown to induce clinical signs, routine eradication therapy seems not to be warranted at present.
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Affiliation(s)
- I Happonen
- Department of Clinical Veterinary Sciences, Faculty of Veterinary Medicine, University of Helsinki, Finland
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Buring SM, Winner LH, Hatton RC, Doering PL. Discontinuation rates of Helicobacter pylori treatment regimens: a meta-analysis. Pharmacotherapy 1999; 19:324-32. [PMID: 10221370 DOI: 10.1592/phco.19.4.324.30939] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We conducted a meta-analysis to determine what factors in treatment regimens for Helicobacter pylori are associated with increased discontinuation rates. Studies were selected from the 1990-1996 MEDLINE data base, and references in published articles and reviews were obtained. Each article was uniformally abstracted for factors that could potentially affect dropout rates. Drug regimens with high numbers of doses per day had highest dropout rates (p=0.0001). The total dropout rate was lowest for regimens containing a proton pump inhibitor (OR = 0.75, CI 0.57, 0.98). The rate was high in regimens containing a bismuth compound due to side effects (OR = 2.79, CI 1.78, 4.36). The main finding was that drug regimens for eradication of H. pylori that have a high number of doses per day result in higher discontinuation rates than regimens with fewer doses per day.
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Affiliation(s)
- S M Buring
- Department of Clinical Pharmacy Practice, Auburn University, Alabama 36849-5502, USA
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Neil GA, Suchower LJ, Johnson E, Ronca PD, Skoglund ML. Helicobacter pylori eradication as a surrogate marker for the reduction of duodenal ulcer recurrence. Aliment Pharmacol Ther 1998; 12:619-33. [PMID: 9701525 DOI: 10.1046/j.1365-2036.1998.00351.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES An abundance of data exists documenting the association of H. pylori eradication with the reduction in duodenal ulcer recurrence. AIM To evaluate the validity of using H. pylori eradication as a surrogate marker for the reduction in duodenal ulcer recurrence using rigorously controlled studies. METHODS Three controlled clinical trials were conducted in patients with uncomplicated, active duodenal ulcers. Patients were treated with various combinations of omeprazole and amoxycillin. Ulcer healing and H. pylori eradication were assessed. For patients whose duodenal ulcer healed, duodenal ulcer recurrence was determined over a 6-month period in patients with H. pylori eradication and those remaining positive for H. pylori at least 4 weeks after treatment. To support the data obtained from these clinical trials, a search of the medical literature was conducted to identify additional human clinical trials in which duodenal ulcer recurrence rates were measured and categorized by H. pylori status at least 1 month post-treatment. RESULTS In 11 controlled trials, the overall 6-18-month duodenal ulcer recurrence rate was 54% among patients remaining positive for H. pylori at least 4 weeks after treatment compared to 6% among patients with H. pylori eradication following treatment. This finding was corroborated by the uncontrolled trials, in which the duodenal ulcer recurrence rate was 64% among patients found to be H. pylori-positive and 6% for patients found to be H. pylori-negative at least 4 weeks after treatment. A time course of duodenal ulcer recurrence rates using pooled data from both controlled and uncontrolled studies demonstrated that duodenal ulcer recurrence rates for H. pylori-negative patients persisted for up to 4 years following treatment. Duodenal ulcer recurrence rates for H. pylori-positive patients increased for the first year, then levelled off. A comparison of the duodenal ulcer recurrence rates for different treatment regimens revealed that eradication regimens based on omeprazole plus antibiotics and bismuth plus antibiotics exhibited similar duodenal ulcer recurrence rates for H. pylori-positive and -negative patients. CONCLUSION Regardless of treatment regimens, H. pylori eradication produced a consistent and significant reduction in duodenal ulcer recurrence. Therefore H. pylori eradication, 4 weeks post-therapy, can be used as a surrogate marker for reduced duodenal ulcer recurrence in investigational clinical trials.
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Affiliation(s)
- G A Neil
- H. pylori Product Development Team, Astra Merck Inc., Wayne, Pennsylvania 19087, USA
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Korman MG, Bolin TD, Engelman JL, Pianko S. Sucralfate as an alternative to bismuth in quadruple therapy for Helicobacter pylori eradication. Helicobacter 1997; 2:140-3. [PMID: 9432342 DOI: 10.1111/j.1523-5378.1997.tb00075.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND There are persuasive arguments for treating all patients with Helicobacter pylori-associated peptic ulcer disease. However, the choice of therapeutic regimen remains problematical. Bismuth triple therapy produces greater than 80% cure of H. pylori infection, whereas omeprazole and bismuth quadruple therapy has produced cure rates in excess of 90%. Colloidal bismuth is not available in many countries, hence limiting the use of bismuth-based therapeutic regimens. We substituted widely available sucralfate for bismuth in a quadruple-therapy regimen. METHOD We studied 223 consecutive patients with gastritis or peptic ulcer disease in whom H. pyori infection was confirmed by CLOtest (Delta West Ltd., Bentley, WA, Australia) or histological assessment. Successful therapy was validated by the 14C urea breath test 4 to 6 weeks after therapy. Omeprazole, 20 mg was given twice daily for 10 days. After 3 days of omeprazole sucralfate (1 gm qid), tetracycline (500 mg qid) and metronidazole (400 mg tid) were added for 7 days. RESULTS Therapy was successful in 194 of 223 patients (87%). Compliance was excellent, with only two patients being unable to tolerate therapy. Side effects were minimal and included nausea, vomiting, headache, and vaginal moniliasis. At 6 months' follow-up, 10 of 210 patients (5%) who were previously documented as "cured" had a positive breath test. CONCLUSIONS The wide availability of sucralfate in many countries makes it a possible alternative to bismuth for use in proton pump quadruple-therapy regimens, achieving a reasonable cure rate for H. pylori infection.
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Affiliation(s)
- M G Korman
- Gastroenterology Unit, Monash Medical Centre, Melbourne, Australia
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Breuer T, Kim JG, Gurer IE, Graham DP, Osato M, Genta RM, Graham DY. Successful low-dose amoxycillin, metronidazole and omeprazole combination therapy in a population with a high frequency of metronidazole-resistant Helicobacter pylori. Aliment Pharmacol Ther 1997; 11:523-7. [PMID: 9218076 DOI: 10.1046/j.1365-2036.1997.00173.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM Effective anti-Helicobacter pylori therapies with few side-effects are needed. We studied the effectiveness of a low-dose combination of metronidazole, amoxycillin and omeprazole for treatment of ulcer patients in Seoul, Korea. METHODS Patients with gastric or duodenal ulcer received metronidazole (125 mg b.d.), amoxycillin (500 mg b.d.) and omeprazole (20 mg at bedtime) for 2 weeks. Endoscopic examinations were performed before treatment and at least 6 weeks after completion of antimicrobial therapy. H. pylori status was confirmed by histological examination of two gastric biopsies using the Genta stain. RESULTS Seventy-nine patients (64 men, 15 women, mean age 46 years) with peptic ulcer were enrolled. H. pylori infection was cured in 56 (71%) 95% CI: 60-81%). The cure rate in non-smokers was significantly higher than in smokers (88% vs. 65%, P = 0.035). Twelve pre-treatment isolates were available and metronidazole resistance was noted in all; H. pylori infection was cured in 10. Thirty-six patients cured of H. pylori have been followed for 1 year (mean of 361 days) and 2 cases became reinfected (5.5%, 95% CI: 1-18%). CONCLUSIONS The low-dose combination of metronidazole, amoxycillin and omeprazole was effective even the in face of metronidazole resistance. Recurrence of H. pylori infection is infrequent even in countries with a high prevalence of H. pylori infection.
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Affiliation(s)
- T Breuer
- Department of Medicine, Veterans Affairs Medical Center, Houston, Texas 77030, USA
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Korman MG. Helicobacter pylori eradication: therapy other than with bismuth or proton-pump inhibitors. SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY. SUPPLEMENT 1996; 220:41-3. [PMID: 8898434 DOI: 10.3109/00365529609094748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Antibiotics alone do not achieve Helicobacter (H. pylori) eradication perhaps because of reduced activity in an acid environment. Some reports suggest that ranitidine combined with amoxicillin and metronidazole is highly successful in eradicating H. pylori, but other have found less success with H2-antagonists. Studies have shown that sucralfate is equally as effective as omeprazole when combined with clarithromycin and metronidazole in achieving H. pylori eradication. Similarly, sucralfate triple therapy (substituted for bismuth) may provide cost efficient treatment. Whilst immunization to protect against Helicobacter infection seems attractive, a large amount of animal work needs to be done before the necessary tedious human trials. Future trends in H. pylori eradication may involve 1-week therapy combining proton-pump inhibitors, bismuth or sucralfate and two antibiotics. It is hoped that such regimens will be simple, effective, relatively inexpensive and free of side effects.
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Affiliation(s)
- M G Korman
- Gastroenterology Unit, Monash Medical Centre, Clayton, Victoria, Australia
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Bateson MC. Gastroenterology--I: Gastroduodenal disease and Helicobacter pylori. Postgrad Med J 1994; 70:561-7. [PMID: 7937449 PMCID: PMC2397689 DOI: 10.1136/pgmj.70.826.561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- M C Bateson
- General Hospital, Bishop Auckland, Co. Durham, UK
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Affiliation(s)
- S K Lam
- Department of Medicine, University of Hong Kong, Queen Mary Hospital
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Abstract
Sucralfate is a site-protective ulcer healing drug with a remarkable range of mechanisms of action. Recent studies highlight the capacity of sucralfate to bind basic fibroblast growth factor (bFGF) and deliver it in high concentration to the ulcer. Basic fibroblast growth factor stimulates the production of granulation tissue, angiogenesis and re-epithelization, thus improving the quality of ulcer healing. The effect of sucralfate in reducing parietal cell sensitivity may be another factor important in the lower relapse rate demonstrated after duodenal ulcer healing. Sucralfate has been demonstrated to be efficacious in healing both duodenal and gastric ulcers together with mild oesophagitis, and it is safe for both short-term use and maintenance. In stress ulcer prophylaxis it is as effective as acid suppression or neutralization and has the advantage of lesser rates of nosocomial pneumonia than are demonstrated with antacids or H2 antagonists. The potential advantages of sucralfate lie in the better quality of ulcer healing associated with longer duration of remission.
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Affiliation(s)
- M G Korman
- Monash Medical Centre, Clayton, Victoria, Australia
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Reijers MH, Noach LA, Tytgat GN. Short report: evaluation of Helicobacter pylori eradication with bismuth sucralfate. Aliment Pharmacol Ther 1994; 8:351-2. [PMID: 7918933 DOI: 10.1111/j.1365-2036.1994.tb00300.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
METHODS In a pilot study we have evaluated the clinical efficacy of bismuth sucralfate to eradicate H. pylori. Ten consecutive patients with chronic dyspepsia and H. pylori associated gastritis were treated with bismuth sucralfate (220 mg bismuth per tablet, 4 tablets per day for 4 weeks). If a 14C urea breath test immediately after the medication was negative, a gastroscopy was performed one month later to obtain biopsies for culture and histological examination. RESULTS Four patients experienced side effects. In none of the ten patients could eradication of H. pylori be demonstrated one month after treatment with bismuth sucralfate. CONCLUSION Bismuth sucralfate is not effective for the treatment of H. pylori infection.
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Affiliation(s)
- M H Reijers
- Department of Gastroenterology-Hepatology, Academic Medical Center, Amsterdam, The Netherlands
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Abstract
The treatment of duodenal ulcer has evolved from ineffective medical treatments through an era of surgical management, back to increasingly effective medical treatment. The advent of H2-receptor antagonists changed the outlook for ulcer patients. More recently, Helicobacter pylori, an organism which inhabits gastric mucosa exclusively, has been implicated in the pathogenesis of peptic ulcer. This bacterium is found in the stomachs of around 95% of duodenal ulcer patients. Its eradication is shown dramatically to improve the rate at which ulcers relapse. The mechanisms whereby it may cause ulceration are not established--we review current hypotheses. No method of eradication is 100% effective, and many different dual or triple therapy regimens have been tried. Metronidazole resistance is reported but its importance is not yet known. Helicobacter eradication is likely to prove a cost-effective and acceptable treatment for duodenal ulcer, and once its value has gained acceptance widespread uptake of this option is anticipated.
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Affiliation(s)
- T G Reilly
- Department of Medicine, Queen Elizabeth Hospital, Edgbaston, Birmingham, U.K
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Iser JH, Buttigieg RJ, Iseli A. Low dose, short duration therapy for the eradication of
Helicobacter pylori
in patients with duodenal ulcer. Med J Aust 1994. [DOI: 10.5694/j.1326-5377.1994.tb126601.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- John H Iser
- Division of GastroenterologyMaroondah Hospital Ringwood East Victoria 3135
| | | | - Anton Iseli
- Division of GastroenterologyMaroondah Hospital Ringwood East Victoria 3135
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Abstract
There are five known environmental, causative factors for peptic ulcer, namely, non-steroidal anti-inflammatory drugs (NSAID), Helicobacter pylori infection, cigarette smoking, environmental stress and dietary habit. There have been six factual, epidemiological observations on peptic ulcer this century: the rise and fall of ulcer frequency in Western societies; geographical variations in ulcer rates; in sex ratios; in duodenal: gastric ulcer ratios; and in placebo healing rates; and seasonal variation in ulcer frequencies. This report examines each of these epidemiological observations to see if each of the environmental factors can explain the observations. The secular trends and the variation in ulcer rates can be related to all the environmental factors. The sex ratios can be explained on the basis of cigarette smoking and environmental stress, whereas the duodenal: gastric ulcer ratios may be ascribed to NSAID use. Placebo healing and seasonal occurrence of ulcer is probably more related to environmental stress. Helicobacter pylori infection alone cannot explain the sex ratios, the duodenal: gastric ulcer ratios, the placebo healing and the seasonal occurrence of ulcer. Cigarette smoking or NSAID use alone does not tally with the seasonal variation of ulcer frequencies. Environmental stress alone does not fit into the recent fall of ulcer rates in Western countries. This report supports the concept of heterogeneity in peptic ulceration.
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Affiliation(s)
- S K Lam
- Department of Medicine, University of Hong Kong, Queen Mary Hospital
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