American Journal of Epidemiology Advance Access originally published online on March 22, 2006
American Journal of Epidemiology 2006 163(11):1025-1034; doi:10.1093/aje/kwj129
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Original Contribution |
Peptic Ulcer Disease in a General Adult Population
The Kalixanda Study: A Random Population-based Study
1 Centre for Family Medicine, Karolinska Institutet, Stockholm, Sweden
2 Kalix Hospital, Kalix, Sweden
3 Astra Zeneca R&D, Mölndal, Sweden
4 Institute of Infectious Disease Control, Stockholm, Sweden
5 Institute of Pathology, Medical Faculty, University of Magdeburg, Magdeburg, Germany
6 Institute of Pathology, Bayreuth, Germany
7 Centre for Enteric Neurosciences and Translational Epidemiological Research, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
8 Department of Medicine, Faculty of Medicine, University of Sydney, Sydney, Australia
Reprint requests to Dr. Pertti Aro, Center for Family and Community Medicine, Karolinska Institutet, Alfred Nobels allé 12, S-141 52 Huddinge, Sweden (e-mail: pertti.aro{at}fimnet.fi).
The authors' aim in this study was to explore the prevalence, symptomatology, and risk factors for peptic ulcer in a general adult population. Between December 1998 and June 2001, the authors surveyed a random sample (n = 3,000) of the adult population (n = 21,610) in two communities in northern Sweden using a validated questionnaire, the Abdominal Symptom Questionnaire (response rate = 74%). A subsample (n = 1,001) of the responders was randomly invited to undergo esophagogastroduodenoscopy and symptom assessment (response rate = 73%). The prevalence of peptic ulcer was 4.1% (20 gastric ulcers and 21 duodenal ulcers). Nausea and gastroesophageal reflux were significant predictors of peptic ulcer disease, but epigastric pain/discomfort was not. Six persons with gastric ulcer and two persons with duodenal ulcer were asymptomatic. Eight subjects with duodenal ulcer (38%) lacked evidence of current Helicobacter pylori infection. Five (25%) of the gastric ulcers and four (19%) of the duodenal ulcers were idiopathic (no use of aspirin or nonsteroidal antiinflammatory drugs, no H. pylori infection). Smoking, aspirin use, and obesity were risk factors for gastric ulcer; smoking, low-dose (
160 mg) aspirin use, and H. pylori infection were risk factors for duodenal ulcer. Peptic ulcer disease often coexists with atypical symptoms or no symptoms at all, and idiopathic duodenal ulcer may be more common than anticipated.
abdominal pain; adult; dyspepsia; endoscopy, digestive system; gastrointestinal diseases; Helicobacter pylori; peptic ulcer
Abbreviations: CI, confidence interval; NSAID(s), nonsteroidal antiinflammatory drug(s); OR, odds ratio; PUD, peptic ulcer disease
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