Complicated and uncomplicated peptic ulcers in a Danish county 1993-2002: a population-based cohort study.
Peptic ulcer epidemiology changes as the proportion of Helicobacter pylori infected people decreases, use of nonsteroidal anti-inflammatory drugs (NSAID) increases, and the proportion of elderly persons increases.


OBJECTIVE
To describe incidence and prognosis of uncomplicated and complicated peptic ulcer patients in Funen County 1993-2002.


METHODS
Data on endoscopies, gastric and duodenal operations, and related peptic ulcer diagnoses were extracted from four population-based databases covering a period from 1974 to 2002. All citizens of Funen County (population 470,000) who between 1993 and 2002 had a peptic ulcer diagnosed for the first time were identified.


RESULTS
Between 1993 and 2002 the incidence of uncomplicated duodenal ulcer decreased from 0.55/1,000 person-years (95% CI 0.49-0.62) to 0.37 (0.31-0.43), uncomplicated gastric ulcer decreased from 0.56 (0.49-0.63) to 0.40 (0.34-0.46), and perforated ulcer decreased from 0.14 (0.11-0.18) to 0.08 (0.06-0.11). The incidence of bleeding peptic ulcer was stable with 0.55 (0.49-0.62) in 1993 and 0.57 (0.51-0.64) in 2002. The proportion of possible NSAID-related incident peptic ulcers increased from 320/827 (39%) in 1993 to 363/686 (53%) in 2002 (p < 0.01). A total of 3,233 patients with incident complicated peptic ulcer (9,927 person-years) and 4,421 patients with incident uncomplicated peptic ulcer (17,773 person-years) was followed for up to 10 yr. The first month following newly diagnosed complicated ulcer the standardized mortality rate was 37.1 (33.4-41.1) during the next 11 months it was 5.1 (4.6-5.6), and in the following years it was 2.6 (2.4-2.8). The corresponding figures for incident uncomplicated peptic ulcer was 11.6 (9.6-13.9), 4.0 (3.6-4.4), and 2.5 (2.3-2.7).


CONCLUSIONS
During the period, incidence of peptic ulcers decreased and an increasing proportion was related to NSAID. Mortality is high.
Department of Medical Gastroenterology, Odense University Hospital, Denmark.
Annmarie
A
Lassen
Jesper
J
Hallas
Ove B
OB
Schaffalitzky de Muckadell
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D004381:Duodenal Ulcer / Q000453:epidemiology; D006801:Humans; D010437:Peptic Ulcer / Q000139:chemically induced / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D010438:Peptic Ulcer Hemorrhage / Q000453:epidemiology; D011379:Prognosis; D013276:Stomach Ulcer / Q000453:epidemiology
D000894:Anti-Inflammatory Agents, Non-Steroidal