Peptic Ulcers - Risk Factors

Risk Factors

About 10% of people in the U.S. are expected to develop peptic ulcers at some point in their lives. Peptic ulcer disease affects all age groups, but it is rare in children. Men have twice the risk of ulcers as women. The risk of duodenal ulcers tends to rise starting at age 25, and continuing until age 75. The risk peaks between ages 55 and 65.

Peptic ulcers are less common than they once were. Research suggests that ulcer rates have even declined in areas where there is widespread H. pylori infection. The increased use of proton pump inhibitor (PPI) drugs may be responsible for this trend. Treatments have also led to a reduction in the rate of H. pylori complications that require a hospital stay. The hospitalization rate for peptic ulcer disease dropped 21% between 1998 and 2005, and hospital stays for H. pylori infection dropped 47% during that same time period.

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Risk Factors for H. pylori

H. pylori bacteria are most likely transmitted directly from person to person. Yet little is known about exactly how these bacteria are transmitted.

About 50% of the world's population is infected with H. pylori. The bacteria are nearly always acquired during childhood and persist throughout life if not treated. The prevalence in children is around 0.5% in industrialized nations, where rates continue to decline. Even in industrialized countries, however, infection rates in regions with crowded, unsanitary conditions are equal to those in developing countries.

It is not entirely clear how the bacteria are transmitted. Suggested, but not clearly proven methods of transmission include:

• Intimate contact, including contact with fluids from the mouth
• GI tract illness (particularly when vomiting occurs)
• Contact with stool (fecal material)
• Sewage-contaminated water

Although H. pylori infection is common, ulcers in children are very rare, and only 5 - 10% of H. pylori-infected adults develop ulcers. Some known risk factors include:

• Smoking
• Using alcohol
• Having a relative with peptic ulcers
• Being male
• Being infected with a bacterial strain that contains the cytotoxin-associated gene A (CagA)