1. Community Medicine V Dr. Mehrdad Askarian MD, MPH Professor of Community Medicine

2. Peptic ulcer & IBD

3. Peptic ulcer epidemiology Trend –Increase till 1960, then decrease hospitalization around 1970. Points regarding epidemiology of PU: –Method of case finding »History, admission, Operation, death, radiography, endoscopy –Season of assessment –DDx with esophagitis, dyspepsia –Management facilities –ICD 9-10 etc.

4. Peptic ulcer epidemiology Age and Sex: –Duodenal ulcer happens 20 years earlier than gastric ones, prevalence in young males is decreasing, but increasing in old age, females. –Increase age increases risk of infection with H. Pylori –Increase prescription of NSAIDs especially in old people. –Cigarette smoking especially among young females.

5. Peptic ulcer epidemiology Geographic distribution, race, social factor –There are differences, but not known the etiology. –Not predictable.

6. Peptic ulcer epidemiology Cigarette smoking –Risk factor for incidence of disease, prevalence, recurrence, complications. Increase risk when smoke more. Decreases wound recovery and increase recurrence. Increase complications, need for operation & post op. complications. Increase mortality rate due to cardiopulmonary and/or wound complications.

7. Peptic ulcer epidemiology Diet –Decrease in fatty acids which causes decrease in mucosal prostaglandins in mucosa that predisposes to duodenal ulcer?? –Rice or wheat?? –Inappropriate food preservation due to microbial contamination. –Coffee??

8. Peptic ulcer epidemiology Gene –O blood group increase risk of duodenal ulcer –20-50% of those who have peptic ulcer have +ve family history of the same disease vs. 5- 15% in those who do not have this history.

9. Peptic ulcer epidemiology H. Pylori About 50% of world population are infected and is equal in both sex. (Australia: 21%, China: 66%, India: 79%), (Iran: 7-18 y/o: 40.9%, 3% increment yearly in this group, >45 y/o is 75.6% which shows 1% increment yearly in this group), better socioeconomic status decrease contamination prevalence. Infection rate differs by age and area of living

10. Peptic ulcer epidemiology H. Pylori –Environmental factors Mostly in young age, crowded areas, families, common vehicles, lack of personal and/or social hygiene. –Genetic factors Identical twins have more co-infection than other age group matched. –Level of education The higher the education, lower the rate of infection

11. Inflammatory bowel disease Ulcerative colitis Crohn disease

12. Ulcerative colitis Epidemiology –Young adult (20-40 y/o) (Iran: 20-50 y/o) –Female>male –White> Black –Socioeconomic class has positive relation

13. Ulcerative colitis Risk factors –Genetic factors More prominent in crohn disease 10-20% in father, mother or siblings. –Environmental factors Infectious agents –E.coli Food hypersensitivity –± milk Cigarette smoking –Is more common in non smokers (in contrast with crohn) OCP –Weak correlation Appendectomy –Has been shown that patients with UC has less history of appendectomy.

14. Crohn disease Increasing the rate of crohn, when uc has decreased or been stable. More common in young age groups, peak in 80 y/o Male=female Genetic factors are involved Environmental factors –Cigarette smoking increases the risk

16. Any Comments or Questions?