TIME TRENDS OF PHYSICIAN VISITS AND TREATMENT PATTERNS OF PEPTIC-ULCER DISEASE IN THE UNITED-STATES

Background: In the last 4 decades, the prevalence rates of peptic ulce r disease and our understanding of its pathophysiological features und erwent major changes. Objective: To analyze how these trends affected physician visits and treatment of ulcer disease. Methods: The National Diseases and Therapeutic Index of IMS America Ltd, Plymouth Meeting, Pa, was used as the data source. Survey data were obtained from a repr esentative sample of US physicians 4 times per year during a 48-hour p eriod and extrapolated to a national level. Physician visits for gastr ic, duodenal, and all peptic ulcers were expressed as rates per 100 00 0 living US population. Results: Between 1958 and 1995, physician visi ts for duodenal ulcer showed a marked decline, while those for gastric ulcer remained largely unchanged. In 1995, 4 million patients visited a physician because of peptic ulcer, corresponding to a rate of 1500 per 100 000 US population. The predominant therapy changed from antich olinergics, tranquilizers, and antacids between 1958 and 1977 to hista mine(2) receptor antagonist from 1978 until 1988, which subsequently b ecame replaced in part by sucralfate and proton pump inhibitors. In 19 95, about 75% of ulcers were still treated primarily with antisecretor y medications, and only 5% received antibiotic therapy. Conclusions: P eptic ulcer is still common, although duodenal ulcer rates continue to decrease. The historical trends of treatment regimens show a steady c hange between various medications. No therapeutic class dominated ulce r therapy for more than 20 years. This trend is likely to continue, pa rticularly, in light of the small fraction currently treated by antibi otics to eradicate Helicobacter pylori.