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Stomach Ulcers Sending Fewer Americans to the Hospital

By Steven Reinberg
HealthDay Reporter

WEDNESDAY, Aug. 11 (HealthDay News) -- Recent advances in understanding the cause of severe peptic ulcers, along with better treatments, may be driving a decline in their incidence, a new study indicates.

From 1998 to 2005, the number of Americans hospitalized for peptic ulcers -- sores in the stomach, esophagus or upper small intestine -- dropped by 21 percent, reports a team from the U.S. Centers for Disease Control and Prevention.

In the 1980s, scientists discovered that many peptic ulcers were linked with the bacteria Helicobacter pylori, and could be effectively treated with antibiotics. That means that most of the 6 million new cases of stomach ulcers reported annually in the United States are now treated outside of the hospital, the researchers said.

"We hypothesized that after the knowledge of the relationship between H. pylori and ulcers became widely known, doctors would prescribe antibiotics for ulcers and patients would be cured," explained lead researcher Lydia B. Feinstein, currently a graduate student at the School of Public Health at the University of North Carolina. "They would therefore be less likely to develop the complications of ulcers, such as bleeding or perforation, that could lead to hospitalization."

The report is published in the September issue of the CDC journal Emerging Infectious Diseases.

In their study, Feinstein's team analyzed data from the Nationwide Inpatient Sample, the largest inpatient-care database in the United States.

"We found that, adjusted for the effects of age, the peptic ulcer hospitalization rate decreased by about 21 percent, from 71 per 100,000 in 1998 to 56 per 100,000 in 2005," Feinstein said.

The hospitalization rate was highest among adults over 65 years of age, with almost 300 hospitalizations per 100,000. The rate was lower in younger age groups, she said.

Overall, men had a higher hospitalization rate than women. However, by 2005 this difference had narrowed because of a greater decline in hospitalization rates for men than for women, Feinstein noted.

The drop in severe ulcers could have multiple causes, she said. "Some of this decrease may have been because over time the proportion of individuals infected with H. pylori is decreasing, perhaps because of better sanitation and hygiene. However, some of this decrease is likely due to the increased use of antibiotics to treat peptic ulcer diseases," Feinstein said.

Most cases of H. pylori infection cause no symptoms, Feinstein noted. However, symptoms such as burning pain in the stomach before, or sometimes after, eating, which may go away with antacids, nausea, bloating, or loss of appetite may be a sign of peptic ulcer disease. In that case, the affected person should see a doctor.

"Your doctor will determine if you have peptic ulcer disease and if you are infected with H. pylori and are a candidate for antibiotic therapy," she said.

Infectious diseases expert Dr. Marc Siegel, an associate professor of medicine at New York University in New York City, countered that "this study doesn't [yet] prove that treating H. pylori decreases the rate of hospitalizations," because there are too many other factors at play to credit antibacterial therapy as the primary cause for the decline.

"However, the study reminds us that H. pylori remains significant in peptic ulcer disease and its complications," he said.

More information

For more information on peptic ulcers, visit the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

SOURCES: Lydia B. Feinstein, Ph.D., graduate student, School of Public Health, University of North Carolina, Chapel Hill; Marc Siegel, M.D., associate professor, medicine, New York University, New York City; September 2010 Emerging Infectious Diseases

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