title: Systematic review of the symptom burden, quality of life impairment and costs associated with peptic ulcer disease.
abstract: BACKGROUND
  Management of peptic ulcer disease has improved over the past few decades. However, the widespread use of nonsteroidal anti-inflammatory drugs and low-dose acetylsalicylic acid means that the burden of peptic ulcer disease remains a relevant issue.
  
  
  METHODS
  We systematically searched PubMed and EMBASE for articles published 1966-2007 that reported symptoms, impairment of well-being or health-related quality of life, and costs associated with peptic ulcer disease.
  
  
  RESULTS
  Thirty studies reported the prevalence of patient-reported gastrointestinal symptoms in individuals with endoscopically diagnosed symptomatic peptic ulcer disease. Average prevalence estimates, weighted by sample size, were 81% (95% confidence interval [CI], 77%-85%) for abdominal pain (11 studies), 81% (95% CI, 76%-85%) for pain specifically of epigastric origin (14 studies), and 46% (95% CI, 42%-50%) for heartburn or acid regurgitation (11 studies). On average, 29% (95% CI, 25%-34%) of patients with peptic ulcer disease presented with bleeding, often as the initial symptom (11 studies). Patients with peptic ulcer disease had significantly lower health-related quality of life than the general population, as measured by the Psychological General Well-Being index (P <.05; 7 studies) and the Short-Form-36 questionnaire (P <.05; 2 studies). Direct medical costs of peptic ulcer disease based on national estimates from several countries were USD163-866 per patient. The most costly aspects of peptic ulcer disease management were hospitalization and medication. Complicated peptic ulcer disease is particularly costly, estimated to be USD1883-25,444 per patient.
  
  
  CONCLUSIONS
  Peptic ulcer disease significantly impairs well-being and aspects of health-related quality of life, and is associated with high costs for employers and health care systems.
authors.affiliation: Division of Gastroenterology, McGill University, Montreal, Quebec, Canada. alan.barkun@muhc.mcgill.ca
authors.forename: Alan
authors.initials: A
authors.lastname: Barkun
authors.forename: Grigorios
authors.initials: G
authors.lastname: Leontiadis
mesh_terms: D006801:Humans; D010437:Peptic Ulcer / Q000139:chemically induced / Q000150:complications* / Q000191:economics*; D011788:Quality of Life