25. Epidemiology and prevention of ulcer disease

From greek.doctor
  • 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