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Gut. Sep 1998; 43(3): 327–333.
PMCID: PMC1727258
Opposing time trends of peptic ulcer and reflux disease
H El-Serag and A Sonnenberg
Department of Veterans Affairs, Medical Center, Albuquerque, USA.
Background—Gastritis associated hypochlorhydria may be protective against gastro-oesophageal reflux disease. It was hypothesised that the historic decline in Helicobacter pylori infection resulted in a decline in peptic ulcer and a concomitant rise in reflux disease.
Aims—To study the time trends of peptic ulcer and reflux disease.
Methods—Hospitalisation rates were analysed using the computerised database of the US Department of Veterans Affairs from 1970 until 1995. Death rates were calculated from the Vital Statistics of the United States.
Results—From 1970 to 1995, hospitalisation rates for gastric and duodenal ulcer, as well as gastric cancer fell, while the hospitalisation rates for gastro-oesophageal reflux disease and those for oesophageal adenocarcinoma rose significantly. Similar time trends were observed with respect to the death rates. There were notable ethnic differences. White subjects incurred higher rates of reflux disease and oesophageal adenocarcinoma and lower rates of gastric ulcer or cancer compared with non-whites.
Conclusions—The ethnic variations and the opposing time trends of gastroduodenal versus oesophageal disease are consistent with the hypothesis that the declining infection rates of H pylori in the general population have led to a rise in the occurrence of gastro-oesophageal reflux disease and associated oesophageal adenocarcinoma.

Keywords: gastric cancer; gastritis; gastro-oesophageal reflux disease; hypochlorhydria; Helicobacter pylori; oesophageal adenocarcinoma
Figure 1
Figure 1
Time trends of hospitalisation for gastric cancer of the corpus or antrum and oesophageal adenocarcinoma/cancer of the cardia. Data points represent the average of consecutive time periods as shown on the x axis.
Figure 2
Figure 2
Time trends of hospitalisation for gastric ulcer, duodenal ulcer, and gastro-oesophageal reflux disease. Data points represent the average of consecutive time periods as shown on the x axis.
Figure 3
Figure 3
Time trends of death rates from gastric cancer of the corpus or antrum and oesophageal adenocarcinoma/cancer of the cardia. Data points represent the average of consecutive time periods as shown on the x axis.
Figure 4
Figure 4
Time trends of death rates from gastric ulcer, duodenal ulcer, and erosive oesophagitis. Data points represent the average of consecutive time periods as shown on the x axis.
Articles from Gut are provided here courtesy of
BMJ Group