Comments on the incidence and natural history of gastric and duodenal ulcer

Epidemiology of peptic ulcer disease

“…Duodenal ulcer used to occur more frequently in urban than in rural communities 55 , since factories and heavy industry were located in the townships. The amount of acid output being proportional to body weight, men secrete more acid than women.…”

Epidemiology of Upper Gastrointestinal Bleeding

“…112 Smoking is also a risk factor, 80,113 and its effect may be mediated through altering the ulcerative effects of Helicobacter pylori. 114 It is possible likewise that smoking to some extent mediates a steep socio-economic gradient long shown to exist for peptic ulcer disease 115 and more recently for upper gastrointestinal haemorrhage also. 22,25 Differences in prescribing practices, alcohol consumption or Helicobacter pylori prevalence may also contribute to this gradient.…”

Cultural Influences on the Incidence and Pattern of Disease

“…Yet any hypothesis for the rise in incidence of duodenal ulcer has also to explain its recession in the South of the United Kingdom since 1950, and also a similar but lesser and slower fall in the North of the country (Susser and Stein, 1962;Pulvertaft, 1968). Two possible reasons present, firstly high though these infants' needs may be, they have been met initially, if at some cost, by a generation of mothers who struggled with the guilt induced by popular interpretations of Freudian teach ings, and from childhood onwards, by the udder of the Welfare State, introduced significantly in 1945 when duodenal ulcer began to decline.…”