Background Peptic ulcer disease (PUD) represents an ongoing global public health concern and is responsible for significant illness and mortality. Despite considerable advancements in medical therapy, the distribution and overall burden of PUD vary substantially across different regions and population segments worldwide. This research provides a comprehensive analysis of the global PUD burden, examining trends from 1990 to 2021 and forecasting patterns until 2050. The findings of this research, which use the most up-to-date epidemiological data available, are significant for epidemiology and disease management.
Methods We leveraged data from the Global Burden of Disease (GBD) 2021 study, which covers 195 countries and territories. Our analysis assessed key metrics of disease impact, including disability-adjusted life years (DALYs), mortality rates, incidence and prevalence data, years lived with disability (YLDs), and years of life lost (YLLs). We calculated age-standardized rates (ASRs) to allow for consistent comparisons across populations. Temporal changes were quantified using estimated annual percentage changes (EAPCs) derived from linear regression. Furthermore, we applied hierarchical cluster analysis to investigate regional patterns in the PUD burden. These methods were chosen because of their robustness and ability to provide a comprehensive understanding of the global burden of PUD.
Results PUD was responsible for an estimated 6.06 million DALYs in 2021 (ASR: 71.56 per 100,000). This burden increased substantially with advancing age, peaking among individuals aged 80 and above. Compared with females, males had higher DALY rates (ASR: 87.02 vs 57.05 per 100,000) and considerably higher mortality rates. Regions with low and low-middle sociodemographic index (SDI) presented the highest ASRs (e.g., 178.38 per 100,000 in low-SDI areas). The highest DALY rates were observed in South Asia and parts of sub-Saharan Africa. Between 1990 and 2021, the global DALY ASR decreased markedly (EAPC: −2.96), though absolute DALY numbers remained elevated in populous, low- to middle-SDI regions. Model-based projections (exponential smoothing and ARIMA), assuming the continuation of recent trends, suggest that ASRs may continue to decline through 2050.
Conclusions Over the past three decades, the global age-standardized burden of PUD has markedly decreased. However, significant challenges remain, particularly for older adults, males, and individuals in low-SDI areas, such as South Asia and sub-Saharan Africa. Although forecasts suggest further reductions in ASRs, the overall burden, influenced by population changes, underscores the crucial need for ongoing, targeted prevention and control efforts. This should prioritize Helicobacter pylori detection and eradication, safer NSAID use with gastroprotection in high-risk patients, and improved access to timely diagnosis and emergency care for ulcer complications in low-SDI regions. These efforts should focus on high-risk groups and regions to ensure equitable progress and should be a priority for all healthcare professionals, researchers, and public health policymakers.
| [1] |
Almadi MA, Lu Y, Alali AA, et al.. Peptic ulcer disease. Lancet., 2024, 404(10447): 68-81.
|
| [2] |
Sverdén E, Agréus L, Dunn JM, et al.. Peptic ulcer disease. BMJ., 2019, 367. ArticleID: l5495
|
| [3] |
Milosavljevic T, Kostić-Milosavljević M, Jovanović I, et al.. Complications of peptic ulcer disease. Dig Dis., 2011, 29(5): 491-493.
|
| [4] |
Tarasconi A, Coccolini F, Biffl WL, et al.. Perforated and bleeding peptic ulcer: WSES guidelines. World J Emerg Surg., 2020, 15: 3.
|
| [5] |
Zhang Z, Yan W, Zhang X, et al.. Peptic ulcer disease burden, trends, and inequalities in 204 countries and territories, 1990–2019: a population-based study. Ther Adv Gastroenterol., 2023, 16: 17562848231210375.
|
| [6] |
Ren J, Jin X, Li J, et al.. The global burden of peptic ulcer disease in 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. Int J Epidemiol., 2022, 51(5): 1666-1676.
|
| [7] |
Rosenstock SJ, Jørgensen T. Prevalence and incidence of peptic ulcer disease in a Danish County—a prospective cohort study. Gut., 1995, 36(6): 819-824.
|
| [8] |
Khan MH, Kamran H, Naveed M, et al. Determinants of peptic ulcer: determinants of peptic ulcer. Pak BioMedical J. 2021;3(1).
|
| [9] |
Huh CW, Kim BW. Clinical significance of risk factors for asymptomatic peptic ulcer disease. Clin Endosc., 2017, 50(6): 514-515.
|
| [10] |
Li Y, Choi H, Leung K, et al.. Global prevalence of Helicobacter pylori infection between 1980 and 2022: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol., 2023, 8(6): 553-564.
|
| [11] |
Szilcz M, Wastesson JW, Calderón-Larrañaga A, et al.. Cholinesterase inhibitors and non-steroidal anti-inflammatory drugs and the risk of peptic ulcers: a self-controlled study. J Am Geriatr Soc., 2024, 72(2): 456-466.
|
| [12] |
Griffin MR. Epidemiology of nonsteroidal anti-inflammatory drug–associated gastrointestinal injury. Am J Med., 1998, 104(3): 23S-29S.
|
| [13] |
Yegen BC. Lifestyle and peptic ulcer disease. Curr Pharm Des., 2018, 24(18): 2034-2040.
|
| [14] |
Kavitt RT, Lipowska AM, Anyane-Yeboa A, et al.. Diagnosis and treatment of peptic ulcer disease. Am J Med., 2019, 132(4): 447-456.
|
| [15] |
Zou Y, Qian X, Liu X, et al.. The effect of antibiotic resistance on Helicobacter pylori eradication efficacy: a systematic review and meta-analysis. Helicobacter., 2020, 25(4. ArticleID: e12714
|
| [16] |
Zhang M. High antibiotic resistance rate: a difficult issue for Helicobacter pylori eradication treatment. World J Gastroenterol., 2015, 21(48): 13432-13437.
|
| [17] |
Yim MH, Kim KH, Lee BJ. The number of household members as a risk factor for peptic ulcer disease. Sci Rep., 2021, 11(1): 5274.
|
| [18] |
Laine L, Nagar A. Long-term PPI use: balancing potential harms and documented benefits. Am J Gastroenterol., 2016, 111(7): 913-915.
|
| [19] |
Singh A, Cresci GA, Kirby DF. Proton pump inhibitors: risks and rewards and emerging consequences to the gut microbiome. Nutr Clin Pract., 2018, 33(5): 614-624.
|
| [20] |
Ketchem CJ, Lynch KL. Potassium-competitive acid blockers and proton pump inhibitors: the dynamic Duo of acid blockers. Gastroenterol Hepatol., 2024, 20(12): 733-738
|
| [21] |
Zhu B, Chen L, Tao X, et al.. Current research status and trends of potassium-competitive acid blockers in the treatment of acid-related diseases: a bibliometric analysis. Front Pharmacol., 2024, 15: 1477633.
|
| [22] |
Patel A, Laine L, Moayyedi P, et al.. AGA clinical practice update on integrating potassium-competitive acid blockers into clinical practice: expert review. Gastroenterology., 2024, 167(6): 1228-1238.
|
| [23] |
Bai Z, Wang H, Shen C, et al.. The global, regional, and national patterns of change in the burden of nonmalignant upper gastrointestinal diseases from 1990 to 2019 and the forecast for the next decade. Int J Surg., 2025, 111(1): 80-92.
|
| [24] |
Cartmell SH. Regenerative technologies: future grand challenges and emerging strategies. Front Med Technol., 2020, 2. ArticleID: 603580
|
| [25] |
Pilotto A. Helicobacter pylori-associated peptic ulcer disease in older patients: current management strategies. Drugs Aging., 2001, 18(7): 487-494.
|
| [26] |
Søreide K, Thorsen K, Harrison EM, et al.. Perforated peptic ulcer. Lancet., 2015, 386(10000): 1288-1298.
|
| [27] |
Yousaf O, Grunfeld EA, Hunter MS. A systematic review of the factors associated with delays in medical and psychological help-seeking among men. Health Psychol Rev., 2015, 9(2): 264-276.
|
| [28] |
Abbasi-Kangevari M, Ahmadi N, Fattahi N, et al.. Quality of care of peptic ulcer disease worldwide: a systematic analysis for the global burden of disease study 1990–2019. PLoS One., 2022, 17(8. ArticleID: e0271284
|
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