The Complex Wane of Peptic Ulcer. II. Trends in Duodenal and Gastric Ulcer Admissions to 790 Hospitals, 1974-1979

Data on duodenal ulcer (DU) and gastric ulcer (GU) admissions to 790 general hospitals during 1974-1979 were analyzed to form more detailed time trends than in Part I. Annual admissions for DU fell less for 1977-1979 than between earlier years; for GU, admissions rose slowly in 1977-1979 after falling in previous years. Decisions about hospitalization may have changed, therefore, to admit proportionately more ulcer patients beginning 1977, the year of cimetidine's release. Also at that time the proportion of patients admitted with complications began to rise, slightly for DU and more steeply for GU; before cimetidine, that proportion had changed little for successive years. Despite the rising number with complications, case fatality rates actually fell in 1977-1979, particularly so in 1978 for DU. A fall in surgery for uncomplicated DU began in Spring 1977, some months before cimetidine became available. Finally, the average hospital stay fell more rapidly after 1977, both for DU and GU, and for surgical and nonoperated patients. The data do not say definitively that cimetidine's apparently protective effect against surgery lasts more than 2 years for uncomplicated DU. Nevertheless, the use of cimetidine, plus the high expectations before its impending release, probably caused the change in trends documented in this study.