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Peptic Ulcer Disease

One of fourteen Americans will have developed ulcers at some time in their life. There are 350,000 new cases per year. A prevalence rate of 18 per 1,000 and a mortality rate of 2.5 per 100,000. We used to ask, "What is the treatment of peptic ulcer disease?" Now we are asking, "What is the cause of peptic ulcer disease?" For years we thought it was just related to acid and peptic ulcer disease. Now we know that more importantly the majority of ulcers are related to non-steroidal anti-inflammatory drugs or Helicobacter pylori. We have rare causes that will keep gastroenterologists in business for awhile, like hypersecretory state, Herpes simplex infection, Crohnís disease and other more unusual causes. But if you just remember that most ulcers are caused either from NSAIDís or from HP, youíll be able to treat more than 50% of ulcers.

We still know that acid and pepsin all play a role in peptic ulcer disease, as well as Helicobacter pylori. Initially acid goes up with Helicobacter pylori infection and then it comes down.

We know that there are still defensive factors, predominately prostaglandin induced, such as the mucosal barrier, the mucous mucosal barrier, bicarbonate, blood flow, and cell regeneration.

The therapeutic goals are pretty easy; to relieve the symptoms, to heal the ulcers and avoid complications. Those were very easily accomplished with the H2 receptor antagonists. However the long-term therapeutic goal was to prevent recurrence and that was not accomplished by treating with H2 receptor antagonist alone. Most of these are very common drugs. We all know about Tagamet, Zantac, Pepcid and Axid. Depending on which study you read and which drug company funded that study, but they all heal about the same. Approximately 80% in four weeks, and approximately 90% with eight weeks of therapy for typical peptic ulcer disease, or duodenal ulcers. There are additional medications with slightly higher increased rates.

We all know that sucralfate, 1 gr. four times a day heals 75% in four weeks, 86% in eight weeks and misoprostol 200 mcg four times a day, 70% in four weeks and 80% in eight weeks. Your compliance, as you know, decreases though with the more times per day you have to give a medication.

The prevalence of Helicobacter pylori is about 1% per year in the United States. It increases with increasing age. We think that once you have this infection, itís a life-long infection and very rarely.