Overall, peptic ulcer disease is declining in the US; however, the incidence of peptic ulcers will vary throughout the country. Immigrants and low-income populations continue to have a relatively high prevalence of peptic ulcers mostly owing to infection with H. pylori. Primary care physicians will occasionally see ulcers that have no clear etiology (idiopathic); these ulcers are likely related to increased acid secretion and these subjects will need to be treated with acid suppressive medications, as was done prior to the discovery of H. pylori. With continued widespread use of NSAIDs, primary care physicians will continue to be confronted with gastrointestinal bleeding and gastric/duodenal ulcers that occur in 1% to 10% of patients taking these medications on a daily basis. The use of proton pump inhibitors or the new cyclooxygenase II (COX-II) specific NSAIDs will help to reduce serious gastrointestinal side effects from conventional NSAIDs.
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