GUT 1998;43:327-333 ( September )

Opposing time trends of peptic ulcer and reflux disease

H B El-Serag, A Sonnenberg

Department of Veterans Affairs Medical Center and University of New Mexico, Albuquerque, New Mexico, USA

Correspondence to: Dr A Sonnenberg, Gastroenterology Section, Department of Veterans Affairs Medical Center 111F, 2100 Ridgecrest Drive SE, Albuquerque, New Mexico 87108, USA.

Accepted for publication 26 March 1998

BackgroundGastritis associated hypochlorhydria may be protective against gastro-oesophageal reflux disease. It was hypothesised that the historic decline in Helicobacter pylori infection resulted in a decline in peptic ulcer and a concomitant rise in reflux disease.
AimsTo study the time trends of peptic ulcer and reflux disease.
MethodsHospitalisation rates were analysed using the computerised database of the US Department of Veterans Affairs from 1970 until 1995. Death rates were calculated from the Vital Statistics of the United States.
ResultsFrom 1970 to 1995, hospitalisation rates for gastric and duodenal ulcer, as well as gastric cancer fell, while the hospitalisation rates for gastro-oesophageal reflux disease and those for oesophageal adenocarcinoma rose significantly. Similar time trends were observed with respect to the death rates. There were notable ethnic differences. White subjects incurred higher rates of reflux disease and oesophageal adenocarcinoma and lower rates of gastric ulcer or cancer compared with non-whites.
ConclusionsThe ethnic variations and the opposing time trends of gastroduodenal versus oesophageal disease are consistent with the hypothesis that the declining infection rates of H pylori in the general population have led to a rise in the occurrence of gastro-oesophageal reflux disease and associated oesophageal adenocarcinoma.
(GUT 1998;43:327-333)

Keywords: gastric cancer;  gastritis;  gastro-oesophageal reflux disease;  hypochlorhydria;  Helicobacter pylori;  oesophageal adenocarcinoma

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© 1998 by Gut
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