Prevalence of peptic ulcer diseases (PUD) differs within countries. In China between 1977 and 1986, the average prevalence of duodenal ulcer in patients undergoing upper endoscopy was 23% in the South and 9.7% in the North, with the average rate of duodenal ulcer almost doubling that of gastric ulcer.1 It has been established that Helicobacter pylori infection is a major cause for PUD.2–4 Approximately half of the world's populations are infected with H. pylori, according to the estimate by the World Health Organization.3 Pooled data obtained in 1991 showed that the prevalence of H. pylori infection in patients with dyspepsia was reported to be about 60% in China.5
Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used for various indications;6 NSAID use increases with age, with 10–20% of the elderly having a current or recent NSAID prescription.6 The use of NSAIDs is associated with various adverse events. Studies have shown that NSAID use is a major risk factor for non-H. pylori-associated PUD, especially gastric ulcer.7, 8 Moreover, NSAIDs increase the risk of peptic ulcer complications by three to fivefold, and responsible for 15–35% of all peptic ulcer complications.9, 10Helicobacter pylori eradication therapy has become part of routine clinical practice for infected patients with PUD.11, 12 Permanent cure of ulcers is achieved in most cases where H. pylori infection is successfully eradicated.4 Following wide spread anti-H. pylori therapy in both primary practice and the hospital setting and particularly, the improvement of socio-economic and living conditions, the prevalence of H. pylori infection and PUD, especially duodenal ulcers, are decreasing in many countries.4, 13, 14 The case is unknown in the Hong Kong Chinese population. Therefore, this study was carried out to investigate the trend in prevalence of PUD, H. pylori infection and frequency of NSAID use in uninvestigated dyspeptic patients referred by family physicians in Hong Kong Chinese.