Epidemiology of gastric and duodenal ulcers.ppt

Epidemiology of gastric and duodenal ulcers Sarah Bowman What is an ulcer? Diagnosis Endoscopy (55yrs, first time). Capture all cases? Faecal / breath tests for H. pylori GI series (rare) False positive tests Missed cases? – risk of transmission / disease progression Why are they important? HPA – “infectious disease” but main effects are from chronic burden Potential “medical emergency” Chronic symptoms – health and economic costs H. pylori also linked to: Functional dypepsia Cancer (2-6x more likely, though still rare) Differential clinical outcome - interaction between bacterial properties (phenotypic variation), genetics and environmental / behavioural factors Emergency admission for perforation Rates per million resident population. Three-year moving averagesImplications for care of older people Causes? Causes Risk Factors Helicobacter pylori 90% duodenal ulcers 70-75% gastric ulcers NSAIDs Lifestyle factors increase risk – smoking, physical stress, salt (GU) Genetic susceptibility / protection against H. pylori infection (twin studies, mouse models) Rarely…Zollinger-Ellison syndrome others Treatment Outcome (NICE) 10% cases fail treatment (HPA) 1 course of combination therapy clears most cases (74% duodenal ulcers) Relapse greater for gastric ulcers (affected by lifestyle factors). At 3-12 months: Duodenal ulcers: 39% clear (acid suppression only); 91% (combination therapy) Gastric ulcers: 45% clear (acid suppression only); 77% (combination therapy) Consequences Primary care – GP consultations, drug costs (increasing resistance) Secondary care – complications, surgery Tertiary care – rarely needed Socio-economic cost: Standardised average annual years of life lost (up to age 75) = 2.6 (per 10,000) (Females=1.8; Males=3.5) (1999 2001 pooled data, ONS) Consequences… “Mass eradication of H?pylori is impractical because of…generating antibiotic resistance, so we need to know how to target prophylaxis.” (Calam Baron 2001) Ulcers occurring in