25. Epidemiology and prevention of ulcer disease

Epidemiology
- Men > women
- 25 – 60 years
- Duodenal ulcers 4x more common than gastric, more common in younger
- Incidence dropping globally
Aggressive factors
- HCl
- Pepsin
- Decreased motility
- H. pylori
  - 6 – 10x increased risk in H. pylori
  - 50% of the world is infected
  - Lifetime risk 10% in H. P negatives and 20% in positives
Protective factors
- Thanks to prostaglandins
- Mucosal blood flow
- Mucin
- Bicarbonate secretion
- Restitution
- Regeneration
Etiology
- Old age
- Long-term NSAID
- Long-term steroid
- Smoking
- Alcohol
- H. pylori infection
- Stress
Prevention
- Primary
  - Enhancement of protective factors
  - Elimination of aggressive factors
  - Increased fibre
  - Decrease caffeine
  - Decrease alcohol
  - Prevent smoking
- Secondary – screening
  - Urea breath test
  - Blood antibody test
  - Gastroscopy
- Tertiary – treatment
  - PPIs, H2 blockers
  - Eradicate H. pylori
  - Stop NSAIDs, steroids
  - Improve diet
  - Stop smoking