Table 6.32, Studies on the association between smoking and peptic ulcer disease, allowing for Helicobacter pylori (H. pylori) infection - The Health Consequences of Smoking

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Office of the Surgeon General (US); Office on Smoking and Health (US). The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2004.

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The Health Consequences of Smoking: A Report of the Surgeon General.

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Table 6.32Studies on the association between smoking and peptic ulcer disease, allowing for Helicobacter pylori (H. pylori) infection

Study/location	Population	Definition of smoking	Results
Martin et al. 1989 United States	107 patients referred for endoscopy, including 14 with duodenal ulcers, 14 with gastric ulcers, and 19 healthy volunteers	>10 cigarettes/day	Prevalence of peptic ulcers among H. pylori-positive patients:
			Smokers	73%
			Nonsmokers	27% (p <0.01)
Schubert et al. 1993 United States	1,088 patients referred for endoscopy, including 107 with duodenal ulcer, 97 with gastric ulcer, and 5 with both duodenal and gastric ulcers	At least 1 cigarette 4 weeks before endoscopy	No significant association was found between smoking and peptic ulcer: prevalence of smoking was 36.7% among ulcer-free group, 42.9% among duodenal ulcer group, and 34.0% among gastric ulcer group (no adjusted estimates provided)
Schlemper et al. 1996 Japan and the Netherlands	215 Japanese and 493 Dutch employees in companies with periodic health screening, including 57 with past peptic ulcers (median 6 years since diagnosis) and 4 with current peptic ulcers	Daily smoking at time of interview	OR (95% CI) adjusted for age, H. pylori infection, family history of peptic ulcers, and occupation, smokers vs. nonsmokers:
			Netherlands (men only)	1.6 (0.5–4.9)
			Japan (men and women)	0.8 (0.3–1.8)
				0.2 (0.1–0.9), duodenal ulcer only
Wang et al. 1996 China	Factory employees: 500 (422 men) with any peptic ulcer within previous 2 years and 500 (396 men) ulcer-free employees	Current (≤15 and >15 cigarettes/day); former smokers excluded	OR^* (95% CI^†) adjusted for age, H. pylori infection, and family history of peptic ulcer among smokers vs. never smokers, by occupation group (men only):
				Workers/drivers	Staff
			Any peptic ulcer
			≤15 cigarettes/day	3.85 (2.29–6.48)	1.24 (0.65–2.39)
			>15 cigarettes/day	5.30 (3.10–9.05)	1.47 (0.66–3.27)
			Duodenal ulcer
			≤15 cigarettes/day	3.38 (1.97–5.79)	1.36 (0.68–2.72)
			>15 cigarettes/day	4.34 (2.49–7.57)	1.36 (0.57–3.22)
Talamini et al. 1997 Italy	495 patients referred for endoscopy, including 69 with duodenal ulcers and 23 with gastric ulcers	1–10 or >10 cigarettes/day	Percentage of those with duodenal ulcer: nonsmokers, 10.8%; smokers 1–10 cigarettes/day, 15.4%; and >10 cigarettes/day, 25.6%; p <0.001
			OR (95% CI) adjusted for gender and H. pylori infection, smokers vs. nonsmokers:
			Duodenal ulcer vs. rest (including gastric ulcer)
			1–10 cigarettes/day	1.35 (0.57–1.38)
			>10 cigarettes/day	2.53 (1.35–4.74)
Halter and Brignoli 1998 Switzerland	282 patients referred for endoscopy, including 24 with duodenal ulcers and 5 with gastric ulcers	Data were not reported	Crude OR (95% CI) vs. for each group vs. other 3 groups combined:
			Duodenal ulcer vs. rest (including gastric ulcer)
			H. pylori-negative nonsmokers	0.13 (0.02–0.93)
			H. pylori-negative smokers	0.37 (not reported)
			H. pylori-positive nonsmokers	0.94 (not reported)
			H. pylori-positive smokers	5.53 (1.97–15.53)

*: OR = Odds ratio.
†: CI = Confidence interval.

From: 6, Other Effects

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Office of the Surgeon General (US); Office on Smoking and Health (US). The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2004. Table 6.32, Studies on the association between smoking and peptic ulcer disease, allowing for Helicobacter pylori (H. pylori) infection.
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