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Epidemiology and etiology of peptic ulcer disease

Section Editor
Mark Feldman, MD, MACP, AGAF, FACG
Deputy Editor
Shilpa Grover, MD, MPH, AGAF


Peptic ulcers are defects in the gastrointestinal mucosa that extend through the muscularis mucosae (picture 1). They persist as a function of the acid or peptic activity in gastric juice. Peptic ulcer disease (PUD) is an important cause of morbidity and health care costs [1].

The natural history of peptic ulcer ranges from resolution without intervention to the development of complications with the potential for significant morbidity and mortality, such as bleeding and perforation. (See "Overview of the complications of peptic ulcer disease".)


The epidemiology of peptic ulcer disease is a reflection of the changing prevalence of Helicobacter pylori infection, the increasing use of non-steroidal anti-inflammatory drugs, and the aging population. Ulcer disease has been decreasing in prevalence since the 1900s and these changes in ulcer prevalence preceded the discovery of Helicobacter pylori.

This dramatic shift in pattern of ulcer disease and of H. pylori-induced gastritis appeared to reflect environmental factors, which changed markedly during this period, rather than genetic bacterial or host factors, which appeared unchanged. One theory suggests that during the early 1900s improved transportation and refrigeration decreased the need for food preservatives and supported a rapid change in diet across the emerging developed nations [2]. The most evident change was from a seasonal diet, in which salt was used as a preservative, to a diet with fresh fruits and vegetables available all year. Furthermore, improved hygiene and overall health in developed countered was associated with reduced rates of childhood infections, which may decrease susceptibility to the pangastritic spread of H. pylori [2].

In developing nations, the majority of children are infected with H. pylori before the age of 10 and adult prevalence peaks at more than 80 percent before age 50. In contrast, in developed countries such as the United States, serologic evidence of H. pylori is uncommon before age 10, increasing to 10 percent in those between 18 and 30 years of age, and to 50 percent in those older than age 60 [3]. (See "Bacteriology and epidemiology of Helicobacter pylori infection".)

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Literature review current through: Nov 2017. | This topic last updated: Sep 19, 2017.
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