Researchers conducted a literature research review to further understand the current evidence regarding diagnosis and treatment for peptic ulcer disease.
Peptic ulcer disease is known to be associated with an increased risk of hospitalization and mortality, according to a literature research review published in JAMA.1 Proton pump inhibitors (PPIs) are the standard treatment options for individuals with the disease, while eliminating patients’ Helicobacter pylori (H pylori) bacterium and discontinuing nonsteroidal anti-inflammatory drugs (NSAIDs) are the best approaches to stopping recurring ulcers.
“A peptic ulcer is defined as a break in the lining of the lower esophagus, the stomach, or upper small intestine (duodenum),” wrote authors of the review. “The estimated prevalence of peptic ulcer disease in the US is 103 per 100,000 population and the annual incidence is 44 per 100,000. Worldwide, the incidence and prevalence of ulcer disease vary, partly due to geographic differences in H pylori infection rates and patterns of NSAID use.”
Incorporate these strategies into your pharmacy practice to improve patient outcomes.
Peptic ulcer disease is prominent worldwide with anywhere from 5% to 10% of the global population developing the disease at some point in their lives.2 However, the trends in peptic ulcer disease mortality and incidence have been difficult to understand in recent history, leading to a need for further research.
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According to a study published in BMC Gastroenterology, the global prevalence of peptic ulcer disease increased 25.8% from the year 1990 to 2019, and has increased further since. However, morbidity and mortality decreased significantly throughout the 30-year study period, despite showing a gradual inclination in the latter part of the study.3
Visualization of a peptic ulcer in the stomach | image credit: decade3d / stock.adobe.com
Researchers believe changes in the risk factors for peptic ulcer disease may have created this noticeable impact in the disease’s global burden. Exploring PubMed literature from January 1, 2000, through April 30, 2024, researchers reviewed clinical trials, meta-analyses, and longitudinal observational studies to further understand trends in peptic ulcer disease rates, as well as common treatments and diagnoses.1
They first gathered a total of 1161 articles for review using the search term “peptic ulcer disease.” Only 95 of the selected articles would be included in the final review, consisting of 57 clinical trials, 24 meta-analyses, and 14 longitudinal observational studies. After gathering literature that met study criteria, researchers then began to understand the risk factors of peptic ulcer disease and the mechanisms that create them.
“The most common risk factors for ulcer disease are [H pylori] infection, which affects approximately 41.8% of people with peptic ulcer disease; aspirin or [NSAID] use, which affects approximately 36.1% of people with peptic ulcer disease; and idiopathic, which affects approximately 22.1% of people,” they continued.1
For the diagnosis of peptic ulcer disease, they found that an endoscopy is the definitive way to identify the disease. With an endoscopy, providers will be able to visualize patients’ ulcers—as well as whether or not the ulcer is bleeding—and possible H pylori infection. Furthermore, they suggest that any patient receiving a peptic ulcer disease diagnosis also seek out an H pylori test.
“Compared with a double-contrast barium test, endoscopy is significantly more sensitive (92% vs 54%) and specific (100% vs 91%) for diagnosing ulcers. Given the large number of patients with epigastric pain who have functional dyspepsia and given the cost of endoscopy, an initial strategy of testing and treating H pylori infection in patients presenting with epigastric pain is recommended by guidelines,” wrote the authors.1
In regard to diagnosis of peptic ulcer disease, H pylori infection is a key indicator, which is why it is also a crucial point of treatment for alleviating disease burden. After the researchers’ review, they discovered a 3-pronged approach to relieving patients of peptic ulcer disease.
First, addressing treatment of the ulcer itself, experts recommend the use of acid inhibition for its ability to heal the ulcer. For disease prevention, they suggested that PPIs be used to eradicate H pylori infection by reducing acidity and working well with other antibiotics in the digestive system. Finally, peptic ulcer disease treatment also focuses on the proper management of other substances, specifically tobacco and NSAIDs, to prevent disease recurrence.
“Peptic ulcer disease is associated with increased rates of hospitalization and mortality. Acid inhibition with PPIs, such as omeprazole or lansoprazole, is the primary treatment. Recurrence of ulcers can be prevented by eradicating H pylori if present and discontinuing aspirin or NSAIDs if applicable,” concluded authors of the study.1
READ MORE: Digestive Health Resource Center
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