Accurate estimates require endoscopic studies because symptoms are insensitive and nonspecific indicators of peptic ulcer. One systematic review of the literature reported an annual incidence of 0.10% to 0.19% for physician diagnosed peptic ulcer disease and a 1-year prevalence of 0.12% to 1.50%.[1]Sung JJ, Kuipers EJ, El-Serag HB. Systematic review: the global incidence and prevalence of peptic ulcer disease. Aliment Pharmacol Ther. 2009 May 1;29(9):938-46.
https://www.doi.org/10.1111/j.1365-2036.2009.03960.x
http://www.ncbi.nlm.nih.gov/pubmed/19220208?tool=bestpractice.com
The prevalence of gastric ulcer varies significantly worldwide; 4.1 % in Sweden and 6.1% in China.[2]Li Z, Zou D, Ma X, et al. Epidemiology of peptic ulcer disease: endoscopic results of the systematic investigation of gastrointestinal disease in China. Am J Gastroenterol. 2010 Aug 24;105(12):2570-7.
http://www.ncbi.nlm.nih.gov/pubmed/20736940?tool=bestpractice.com
[3]Aro P, Storskrubb T, Ronkainen J, et al. Peptic ulcer disease in a general adult population: the Kalixanda study: a random population-based study. Am J Epidemiol. 2006 Jun 1;163(11):1025-34.
http://www.ncbi.nlm.nih.gov/pubmed/16554343?tool=bestpractice.com
The incidence of peptic ulcer increases with age; gastric ulcers peak in the fifth to seventh decades and duodenal ulcers 10 to 20 years earlier.[4]Sonnenberg A. Temporal trends and geographical variations of peptic ulcer disease. Aliment Pharmacol Ther. 1995;9 Suppl 2:3-12.
http://www.ncbi.nlm.nih.gov/pubmed/8547525?tool=bestpractice.com
Both sexes are similarly affected.
The epidemiology of peptic ulcer disease largely reflects the epidemiology of the two major etiologic factors, Helicobacter pylori infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs). In the developed world, H pylori incidence has been slowly declining over the past 50 years and NSAID use has increased. Most studies report that peptic ulcers are decreasing in prevalence over time.[5]Cai S, García Rodríguez LA, Massó-González EL, et al. Uncomplicated peptic ulcer in the UK: trends from 1997 to 2005. Aliment Pharmacol Ther. 2009 Nov 15;30(10):1039-48.
https://www.doi.org/10.1111/j.1365-2036.2009.04131.x
http://www.ncbi.nlm.nih.gov/pubmed/19709097?tool=bestpractice.com
[6]Nam K, Shin JE, Kim SE, et al. Prevalence and risk factors for upper gastrointestinal diseases in health check-up subjects: a nationwide multicenter study in Korea. Scand J Gastroenterol. 2018 Aug;53(8):910-6.
http://www.ncbi.nlm.nih.gov/pubmed/30169983?tool=bestpractice.com
[7]Sonnenberg A, Turner KO, Genta RM. Low prevalence of Helicobacter pylori-positive peptic ulcers in private outpatient endoscopy centers in the United States. Am J Gastroenterol. 2020 Feb;115(2):244-50.
http://www.ncbi.nlm.nih.gov/pubmed/31972622?tool=bestpractice.com
[8]Ran J, Jin X, Li J, et al. The global burden of peptic ulcer disease in 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. Int J Epidemiol. 2022 Oct 13;51(5):1666-76.[9]Azhari H, King JA, Coward S, et al. The global incidence of peptic ulcer disease is decreasing since the turn of the 21st century: a study of the organisation for economic co-operation and development (OECD). Am J Gastroenterol. 2022 Sep 1;117(9):1419-27.
http://www.ncbi.nlm.nih.gov/pubmed/35973143?tool=bestpractice.com
Nevertheless they remain a problem, especially in the developing world where H pylori infection is highly prevalent.[10]Suerbaum S, Michetti P. Helicobacter pylori infection. New Engl J Med. 2002 Oct 10;347(15):1175-86.
http://www.ncbi.nlm.nih.gov/pubmed/12374879?tool=bestpractice.com
A 2019 literature review of the epidemiology of peptic ulcer disease (PUD) in Africa found heterogeneity in the prevalence and incidence of PUD across the continent. However, most of the tertiary-center studies found a higher prevalence of PUD in Africa when compared with similar studies in western countries.[11]Archampong TN, Asmah RH, Richards CJ, et al. Gastro-duodenal disease in Africa: literature review and clinical data from Accra, Ghana. World J Gastroenterol. 2019 Jul 14;25(26):3344-58.
https://www.wjgnet.com/1007-9327/full/v25/i26/3344.htm
http://www.ncbi.nlm.nih.gov/pubmed/31341360?tool=bestpractice.com