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Aliment Pharmacol Ther 2010; 32: 901–907 Background The risk of dying from gastric cancer appears to have increased among consecutive generations born during the 19th century. Aim To follow the time trends of hospitalization for gastric cancer and test whether they confirm such increase. Methods Inpatient records of the last two centuries from four hospitals in Scotland and three US hospitals were analysed. Proportional rates of hospitalization for gastric cancer, gastric ulcer and duodenal ulcer were calculated during consecutive 5-year periods. Results The data from all seven cities revealed strikingly similar patterns. No hospital admissions for gastric cancer or peptic ulcer were recorded prior to 1800. Hospital admissions for gastric cancer increased in an exponential fashion throughout the 19th and the beginning of the 20th century. In a majority of cities, the rise in hospitalization for gastric cancer preceded a similar rise in hospitalization for gastric ulcer. Hospitalization for these two latter diagnoses clearly preceded hospitalization for duodenal ulcer by 20–40 years. Conclusions The occurrence of gastric cancer, gastric ulcer and duodenal ulcer markedly increased during the 19th century. Improvements in hygiene may have resulted in the decline of infections by other gastrointestinal organisms that had previously kept concomitant infection by Helicobacter pylori suppressed. [ABSTRACT FROM AUTHOR]

Indigestion and heartburn have been described for thousands of years, but it was only in the 16th century that the disease peptic ulcer was established by autopsy. At first, only gastric ulcers were identified. In the 18th century, duodenal ulcers, most of which were fatal cases after perforation or hemorrhage, were seen. In the 19th century, when autopsy became a common, even routine, hospital procedure, uncomplicated acute and chronic ulcers were found and then correlated with symptoms. Thus, our current clinical understanding dates from the 1820s, by which time peptic ulcers were being reported in the U.S. It is unclear why gastric ulcers were not diagnosed at The Mount Sinai Hospital until 1873 and duodenal ulcers until 1885. However, after that time both conditions were diagnosed frequently, and they rapidly became common and were treated medically and surgically.