Trends in the prevalence of peptic ulcer disease and Helicobacter pylori infection in family physician-referred uninvestigated dyspeptic patients in Hong Kong B. XIA*, H. H. X. XIA  , C. W. MA*, K. W. WONG  , F. M. Y. FUNG  , C. K. HUI  , C. K. CHAN  , A. O. O. CHAN  , K. C. LAI  , M. F. YUEN  & B. C. Y. WONG   *Department of Internal Medicine, Research Center of Digestive Diseases of Zhongnan Hospital, Key Laboratory of Allergy and Immune-related Diseases, Wuhan University School of Medicine, China;  Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China Accepted for publication 25 May 2005 SUMMARY Background: Peptic ulcer disease is mainly caused by Helicobacter pylori infection and the use of non-steroidal anti-inflammatory drugs. Aim: To investigate the trends in the prevalence of peptic ulcer disease, H. pylori infection and non-steroidal anti-inflammatory drug use in uninvestigated dyspeptic patients over recent years in Hong Kong. Methods: Data from consecutive patients with uninves- tigated dyspeptic symptoms referred by family physi- cians for open access upper endoscopy during 1997 and 2003 were analysed in relation to peptic ulcer disease, H. pylori infection and non-steroidal anti-inflammatory drug use. Results: Among 2700 patients included, 405 (15%) had peptic ulcer disease and 14 (0.5%) had gastric cancer. There was a reduced trend from 1997 to 2003 in the prevalence of peptic ulcer disease (17, 20, 14, 16, 13, 14 and 14%, respectively, v 2 ¼ 5.80, P ¼ 0.016) (mainly because of decrease in duodenal ulcers), H. pylori infection (44, 50, 49, 44, 40, 40, 36 and 43%, respectively, v 2 ¼ 13.55, P < 0.001) and non-steroidal anti-inflammatory drug use (13, 5, 5, 6, 3, 4, 4 and 5% respectively, v 2 ¼ 13.61, P < 0.001). The prevalence of peptic ulcer disease, H. pylori infection and non-steroidal anti-inflammatory drug use between 2001 and 2003 were significantly lower than that between 1997 and 2000 (17% vs. 13%, OR ¼ 0.78, 95% CI: 0.63–0.96, P ¼ 0.020 for peptic ulcer disease; 47% vs. 39%, OR ¼ 0.72, 95% CI: 0.60–0.86, P < 0.001 for H. pylori infection; and 6% vs. 4%, OR ¼ 0.56, 95% CI: 0.39– 0.82, P ¼ 0.002 for non-steroidal anti-inflammatory drug use). H. pylori infection was associated with both duodenal ulcer (OR ¼ 15.87, 95% CI: 10.60–23.76, P < 0.001) and gastric ulcer (OR ¼ 3.12, 95% CI: 2.15–4.53, P < 0.001) whereas non-steroidal anti- inflammatory drug use was only associated with gastric ulcer (OR ¼ 2.97, 95% CI: 1.70–5.20, P < 0.001). Conclusions: The prevalence of peptic ulcer disease, mainly duodenal ulcers, was reduced in association with a decreasing trend in the prevalence of H. pylori infection and non-steroidal anti-inflammatory drug use from 1997 to 2003. INTRODUCTION Prevalence of peptic ulcer diseases (PUD) differs within countries. In China between 1977 and 1986, the average prevalence of duodenal ulcer in patients Correspondence to: Dr B. C. Y. Wong, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China. E-mail: bcywong@hku.hk Aliment Pharmacol Ther 2005; 22: 243–249. doi: 10.1111/j.1365-2036.2005.02554.x Ó 2005 Blackwell Publishing Ltd 243