ON THE NATURAL-HISTORY OF PEPTIC-ULCER

Background: Three out of 1000 individuals have peptic ulcer every year , and 20% of the ulcer episodes are associated with bleeding. Whether major innovations such as endoscopy and strong acid-suppressing drugs have had any impact on the natural course of peptic ulcer disease is l argely unknown. Methods: Three hundred and fifty-one patients (median age, 63 years) with endoscopically proven peptic ulcer during 1979-198 4 were included in the study and retrospectively followed up via medic al records. The total population is based on two different groups of p atients, the first comprising 229 consecutively diagnosed ulcer patien ts during 1979-81 and, to increase the number of bleeders. a second gr oup including 122 bleeding ulcer patients consecutively diagnosed duri ng 1981-84. At the end of the follow-up period all non-ulcer-operated patients were asked to answer a questionnaire on symptoms, investigati ons, and medication. Results The male to female ratio was 2.4:1 in duo denal ulcer patients, but a 1:1 ratio was shown both in gastric and pr epyloric/pyloric ulcer patients (p < 0.001). Patients with bleeding ul cers were significantly older than non-bleeders (68 years versus 58 ye ars; p < 0001), as were patients with gastric ulcers compared with pre pyloric/pyloric or duodenal ulcer patients (68 years versus 63 and 61 years, respectively; p < 0.01). The 10-year cumulative mortality in th e unselected group (median age, 62 years) was 43%, and the annual risk of dying of peptic ulcer disease was 0.6%. No difference in 10-year r ecurrence rate was seen between patients with bleeding ulcer at inclus ion and non-bleeders (46.2% versus 44.3%; p = NS), but the annual risk of bleeding was 5.3% and 0.8%, respectively (p < 0.0001). In the grou p of patients answering the questionnaire 51% reported upper abdominal pain during the last year of follow-up. Conclusions: In spite of toda y's treatment regimens almost half of the patients with peptic ulcer d isease experienced recurrence during a 10-year period, and more than h alf had ulcer symptoms after 10 years. Most probably, maintenance trea tment with H-2-receptor antagonists should have been offered more libe rally during the 1980s.