Time trends of physician visits and treatment patterns of peptic ulcer disease in the United States

Background: In the last 4 decades, the prevalence rates of peptic ulcer disease and our understanding of its pathophysiological features underwent major changes. Objective: To analyze how these trends affected physician visits and treatment of ulcer disease. Methods: The National Diseases and Therapeutic Index of IMS America Ltd, Plymouth Meeting, Pa, was used as the data source. Survey data were obtained from a representative sample of US physicians 4 times per year during a 48-hour period and extrapolated to a national level. Physician visits for gastric, duodenal, and all peptic ulcers were expressed as rates per 100 000 living US population. Results: Between 1958 and 1995, physician visits for duodenal ulcer showed a marked decline, while those for gastric ulcer remained largely unchanged. In 1995, 4 million patients visited a physician because of peptic ulcer, corresponding to a rate of 1500 per 100 000 US population. The predominant therapy changed from anticholinergics, tranquilizers, and antacids between 1958 and 1977 to histamine(2) receptor antagonist from 1978 until 1988, which subsequently became replaced in part by sucralfate and proton pump inhibitors. In 1995, about 75% of ulcers were still treated primarily with antisecretory medications, and only 5% received antibiotic therapy. Conclusions: Peptic ulcer is still common, although duodenal ulcer rates continue to decrease. The historical trends of treatment regimens show a steady change between various medications. No therapeutic class dominated ulcer therapy for more than 20 years. This trend is likely to continue, particularly, in light of the small fraction currently treated by antibiotics to eradicate Helicobacter pylori.