PMID- 19379513
OWN - NLM
STAT- MEDLINE
DCOM- 20090623
LR  - 20211020
IS  - 1471-230X (Electronic)
IS  - 1471-230X (Linking)
VI  - 9
DP  - 2009 Apr 20
TI  - Decreasing incidence of peptic ulcer complications after the introduction of the 
      proton pump inhibitors, a study of the Swedish population from 1974-2002.
PG  - 25
LID - 10.1186/1471-230X-9-25 [doi]
AB  - BACKGROUND: Despite a decreasing incidence of peptic ulcer disease, most previous 
      studies report a stabile incidence of ulcer complications. We wanted to 
      investigate the incidence of peptic ulcer complications in Sweden before and 
      after the introduction of the proton pump inhibitors (PPI) in 1988 and compare 
      these data to the sales of non-steroid anti-inflammatory drugs (NSAID) and 
      acetylsalicylic acid (ASA). METHODS: All cases of gastric and duodenal ulcer 
      complications diagnosed in Sweden from 1974 to 2002 were identified using the 
      National hospital discharge register. Information on sales of ASA/NSAID was 
      obtained from the National prescription survey. RESULTS: When comparing the 
      time-periods before and after 1988 we found a significantly lower incidence of 
      peptic ulcer complications during the later period for both sexes (p < 0.001). 
      Incidence rates varied from 1.5 to 7.8/100000 inhabitants/year regarding 
      perforated peptic ulcers and from 5.2 to 40.2 regarding peptic ulcer bleeding. 
      The number of sold daily dosages of prescribed NSAID/ASA tripled from 1975 to 
      2002. The number of prescribed sales to women was higher than to males. Sales of 
      low-dose ASA also increased. The total volume of NSAID and ASA, i.e. over the 
      counter sale and sold on prescription, increased by 28% during the same period. 
      CONCLUSION: When comparing the periods before and after the introduction of the 
      proton pump inhibitors we found a significant decrease in the incidence of peptic 
      ulcer complications in the Swedish population after 1988 when PPI were introduced 
      on the market. The cause of this decrease is most likely multifactorial, 
      including smoking habits, NSAID consumption, prevalence of Helicobacter pylori 
      and the introduction of PPI. Sales of prescribed NSAID/ASA increased, especially 
      in middle-aged and elderly women. This fact seems to have had little effect on 
      the incidence of peptic ulcer complications.
FAU - Hermansson, Michael
AU  - Hermansson M
AD  - Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden. 
      michael.hermansson@vgregion.se
FAU - Ekedahl, Anders
AU  - Ekedahl A
FAU - Ranstam, Jonas
AU  - Ranstam J
FAU - Zilling, Thomas
AU  - Zilling T
LA  - eng
PT  - Journal Article
DEP - 20090420
PL  - England
TA  - BMC Gastroenterol
JT  - BMC gastroenterology
JID - 100968547
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 0 (Anti-Ulcer Agents)
RN  - 0 (Proton Pump Inhibitors)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Aged
MH  - Anti-Inflammatory Agents, Non-Steroidal/adverse effects
MH  - Anti-Ulcer Agents/*therapeutic use
MH  - Aspirin/adverse effects
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Gastrointestinal Hemorrhage/chemically induced/*epidemiology/etiology
MH  - Helicobacter Infections/complications
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Peptic Ulcer/*complications/*drug therapy
MH  - Peptic Ulcer Perforation/chemically induced/*epidemiology/etiology
MH  - Proton Pump Inhibitors/*therapeutic use
MH  - Retrospective Studies
MH  - Smoking/adverse effects
MH  - Sweden/epidemiology
PMC - PMC2679757
EDAT- 2009/04/22 09:00
MHDA- 2009/06/24 09:00
PMCR- 2009/04/20
CRDT- 2009/04/22 09:00
PHST- 2007/11/23 00:00 [received]
PHST- 2009/04/20 00:00 [accepted]
PHST- 2009/04/22 09:00 [entrez]
PHST- 2009/04/22 09:00 [pubmed]
PHST- 2009/06/24 09:00 [medline]
PHST- 2009/04/20 00:00 [pmc-release]
AID - 1471-230X-9-25 [pii]
AID - 10.1186/1471-230X-9-25 [doi]
PST - epublish
SO  - BMC Gastroenterol. 2009 Apr 20;9:25. doi: 10.1186/1471-230X-9-25.