Changing clinical pattern of gastric ulcer: are anti-inflammatory drugs involved?

The changing pattern of gastric ulcer (GU) has been studied in a series of 528 cases presenting in one hospital department during the past 20 years. The male:female ratio has declined and is now equal, and age-adjusted figures show that this applies to all age groups. There was a significant decline in mid-gastric ulcers in men. There was a 4-fold increased incidence of haemorrhage in proximal as opposed to antral ulcers and a 7-fold excess of haemorrhage in older women as opposed to younger women. GU in elderly women taking non-aspirin non-steroidal anti-inflammatory drugs (NANSADs) showed an increased tendency to bleeding, accounting for half of all haemorrhages in women over 70 years. However, on statistical analysis NANSAD-associated ulcers showed no other distinguishing features, and the use of NANSADs did not contribute significantly to the changing sex ratio. There is still no satisfactory evidence that these drugs play a causal role in chronic GU.