Peptic Ulcer: A Profile

Abstract

Over a period of 15 years 265 persons with peptic ulcers have been followed up in a general practice of over 6,000 patients. Diagnosis was based on radiological confirmation. The functional status was assessed by classifying the condition in each case in one of four grades, from 1 to 4. These gradings were estimated at five-year periods. These 265 persons consisted of 212 with duodenal ulcers, 176 males and 36 females (M : F —4.9 : 1), and 53 with gastric ulcers, 28 males and 25 females (M: F = l.l : 1). The cumulative prevalence rate in adults was 5.3%. The annual incidence rate for the practice as a whole was 4.2 per 1,000, and if this is representative there may be 250,000 new peptic ulcer cases occurring each year in the United Kingdom. The annual prevalence rate was 16 per 1,000, and this suggests that each general practitioner may have to manage at least 40 such patients each year. The onset of symptoms differed in the two types of ulcer and in the two sexes. In duodenal ulcer, in males the first symptoms occurred most often at age 30–39 and in females at 40–49. In gastric ulcer, in males the most frequent period of onset was at age 50–59 and in females at 60–69. During the 15-year period of observation there was a very definite tendency towards natural remission. The most usual course was that once symptoms began there followed a period of activity with frequent episodes of disabling pain, the severity of symptoms reaching a peak after 5–10 years, followed by a period of progressive remission and eventual complete control of disability. This “ peak ” was reached in 8.1 years in males with duodenal ulcer, in 7.1 years in females with duodenal ulcer, in 6.5 years in males with gastric ulcer, and in 6.8 years in females with gastric ulcer. Surgical treatment was required in 16.2% of patients—16% in duodenal ulcers and 19% in gastric ulcers. The results were very satisfactory for control of ulcer-symptoms, but one-third of those who had a gastrectomy developed anaemia 5–10 years after the operation. Complications of duodenal and gastric ulcers included haemorrhage in 16% and perforation of the ulcer in 6%. Males with duodenal ulcers were five times more likely than expected to develop pulmonary tuberculosis, three times more likely to suffer neuroses, and twice as likely to develop coronary heart disease or chronic bronchitis. © 1964, British Medical Journal Publishing Group. All rights reserved.