Novel Data Analyses Explain the Birth-Cohort Phenomenon of Peptic Ulcers

Abstract

Background: In 1962, Susser and Stein observed that the mortality rates of peptic ulcers in England and Wales increased markedly in the 1910s, maintained at a high level during the 1910s-1940s, and began to decline steadily since the early 1950s. They termed this epidemic pattern a birth-cohort phenomenon, but its mechanism has never been elucidated. Susser and Stein speculated that the occurrences of extraordinary social environmental factors roughly fit the fluctuations, but the role of environmental factors in peptic ulcers has never been identified. Objectives: This study aims to elucidate the mechanism of the birth-cohort phenomenon of peptic ulcers and identify the role of environmental factors in the disease. Methods: Starting from an etiology identified recently, this study uses the two inverse operations in calculus, differentiation, and integration, to analyze the existing data. First, a fluctuation curve in the birth-cohort phenomenon is differentiated into multiple annual mortality rates caused by individual environmental factors. Second, these annual mortality rates are integrated to reproduce the fluctuation curve in the birth-cohort phenomenon. Results: The differentiation reveals a parallel relationship between the psychological impacts of environmental factors and the mortality rates of peptic ulcers, whereas the integration reproduces a representative fluctuation curve in the birth-cohort phenomenon. The successive occurrences of multiple social environmental factors from the 1910s to 1940s maintained the increase in mortality rates, while the sustained improvements in living environments explained the steady decline of the mortality rates from the early 1950s. Conclusion: The parallel relationship suggests a causal role of environmental factors in peptic ulcers, whereas the reproduction of a representative fluctuation curve indicates that multiple environmental factors caused the birth-cohort phenomenon by Superposition Mechanism. Significantly, this study challenges the current reductionist approach used to study disease in modern medicine by demonstrating the effectiveness of an opposite methodological concept focused on integration.

‘Peptic Ulcers Are an Infectious Disease Caused by Helicobacter pylori’ Is an Illusion in Medical Research

“…Encouragingly, this etiology explained all the 15 characteristics and 81 observations/phenomena of peptic ulcers [34], including all the 36 observations/phenomena associated with the bacterium. Moreover, this etiology addressed all the controversies and mysteries related to peptic ulcers, such as the birth-cohort phenomenon [35] and seasonal variation [36], and the morphology and predilection sites [33], as well as the roles of gastric acid, H. pylori, and NSAIDs in the disease [32,33]. The similarities and differences between duodenal and gastric ulcers are also clarified [33].…”

“…In contrast, based on "peptic ulcers are a psychosomatic disease triggered by psychological stress", Theory of Nodes explained all three epidemiological observations. This theory elucidated that the mortality rates of peptic ulcers are parallel with the psychological impacts of multiple environmental factors, which cause the birth-cohort phenomena and seasonal variation by superposition mechanism [35,36]. As per the birth-cohort phenomena, the psychological stress caused by a succession of crucial social events maintained the increased mortality rates from the 1910s to 1940s, whereas the sustained improvements in living environments led to the steady decline of the mortality rates since the early 1950s [35].…”

“…This theory elucidated that the mortality rates of peptic ulcers are parallel with the psychological impacts of multiple environmental factors, which cause the birth-cohort phenomena and seasonal variation by superposition mechanism [35,36]. As per the birth-cohort phenomena, the psychological stress caused by a succession of crucial social events maintained the increased mortality rates from the 1910s to 1940s, whereas the sustained improvements in living environments led to the steady decline of the mortality rates since the early 1950s [35]. Similarly, it is the psychological stress induced by seasonal changes that account for the seasonal variation of peptic ulcers [36].…”

“…All explained [32][33][34][35][36] Addressed: H. pylori is not an etiological factor but plays a secondary role in only the late phase of ulceration [32][33][34].…”

“…Due to a limit of words, the data analyses are summarized into a series of 6 articles (Supplementary Table S1). In the first five articles of the series, 14 major characteristics and 73 observations/phenomena of peptic ulcers, most of which have never been fully understood before, have been explicitly elucidated [32][33][34][35][36]. This analysis is the sixth one of the series, aiming to address the controversies surrounding the role of H. pylori in peptic ulcers, along with the mystery of the African enigma.…”