Clinical trends in ulcer diagnosis in a population with high prevalence of Helicobacter pylori infection M. A. PE ´ REZ-AISA*, D. DEL PINO  , M. SILES à & A. LANAS* *Service of Digestive Diseases, University Hospital, Zaragoza;  Department of Preventive Medicine, University Hospital, Zaragoza, Spain; àUnit of Pharmaceutical Inspection of the Service of Pharmacy of Servicio Aragone ´s de Salud Zaragoza, Spain Accepted for publication 4 October 2004 SUMMARY Background: It is unknown whether the incidence of peptic ulcer changes in areas with a high prevalence of Helicobacter pylori infection. Aim: To determine trends in peptic ulcer complications in a community with a high prevalence of H. pylori infection. Methods: New endoscopic diagnoses of peptic ulcers and their complications from 1985 to 2000 were obtained. H. pylori infection in the adult population, the number of prescriptions for anti-secretory drugs and non-steroidal anti-inflammatory drugs were also evaluated. Results: Although the global prevalence of H. pylori infection remains high in this population (>60%), a 41.4 to 25.4% decrease in the incidence of peptic ulcers and ulcer complications was observed. This was associated with a decrease in the prevalence of H. pylori infection in people under 65 years of age, a 3.5-fold increase in the number of prescriptions of proton-pump inhibitors and an increase in the number of prescriptions of non- steroidal anti-inflammatory drugs, especially coxibs. Conclusions: In an area with a high prevalence of H. pylori infection, the incidence of peptic ulcer and associated complications is declining rapidly. This was associated with a reduction of the prevalence of H. pylori infection in the young and a widespread use of proton- pump inhibitors. The increase in the use of non-steroidal anti-inflammatory drugs, especially coxibs, has not changed the tendency. INTRODUCTION Over the last few years a decrease in the prevalence of uncomplicated gastroduodenal peptic ulcer expressed as a decline in hospital admission rates and mortality from peptic ulcer has been reported. 1, 2 In contrast to these general trends, some studies have shown an increase in the mortality rates from duodenal ulcers and in the admissions for perforated peptic ulcers in western countries 3–5 especially among the elderly. 6, 7 The decrease in the trends of non-complicated ulcers had been attributed to a reduced prevalence of Helicob- acter pylori infection because of an improvement in the socio-sanitary conditions and the antibiotic treatments to eradicate H. pylori. 4, 8 However, there are no data regarding trends in peptic ulcer disease in countries with a high prevalence of H. pylori. Furthermore, there are a number of potential factors, in addition to the prevalence of H. pylori infection that may affect the incidence of peptic ulcer diagnosis and that have not been properly studied or evaluated in this setting. Some of these factors are of paramount importance, as they may either increase or decrease the incidence of peptic ulcer diseases and complications. In this way, antise- cretory drugs are now widely prescribed, but the Correspondence to: Dr A. Lanas, Service of Digestive Diseases, University Hospital, C/San Juan Bosco, 15, 50009 Zaragoza, Spain. E-mail: alanas@posta.unizar.es Aliment Pharmacol Ther 2005; 21: 65–72. doi: 10.1111/j.1365-2036.2004.02297.x Ó 2005 Blackwell Publishing Ltd 65