Smoking and ulcer perforation

C Svanes,^a J A Søreide,^b A Skarstein,^c B T Fevang,^a P Bakke,^d S E Vollset,^e K Svanes,^a O Søreide^f

^a Department of Surgery, Haukeland University Hospital, Bergen, ^b Department of Surgery, Rogaland Hospital, Stavanger, ^c Department of Surgery, Haraldsplass University Hospital, Bergen, ^d Department of Thoracic Medicine, Haukeland University Hospital, Bergen, ^e Section for Medical Informatics and Statistics, University of Bergen, ^f National Hospital, University of Oslo, Norway

Correspondence to: Dr C Svanes, Department of Thoracic Medicine, University of Bergen, 5021 Haukeland Hospital, Norway.

Accepted for publication 10 March 1997

BackgroundThe use of ulcerogenic drugs is the only well documented risk factor for peptic ulcer perforation, but accounts for only a quarter of the events. Smoking is a well known risk factor for uncomplicated ulcer disease, and patients with ulcer bleeding have increased death rates from smoking related disorders.
AimTo assess the role of smoking in ulcer perforation.
SubjectsA total of 168 consecutive patients with gastroduodenal ulcer perforation and 4469 control subjects from a population based health survey.
MethodsThe association between ulcer perforation and smoking habits was analysed by logistic regression while adjusting for age and sex.
ResultsCurrent smoking increased the risk for ulcer perforation 10-fold in the age group 15-74 years (OR 9.7, 95% CI 5.9 to 15.8) and there was a highly significant dose-response relationship (p<0.001). The results were similar in men (OR 9.3, 95% CI 4.9 to 17) and women (OR 11.6, 95% CI 5.3 to 25), and for gastric (OR 10.5, 95% CI 4.5 to 25) and duodenal (OR 8.6, 95% CI 4.9 to 15.4) ulcer perforation. No increase in risk was found in previous smokers (OR 0.8, 95% CI 0.2 to 2.2).
ConclusionOur findings suggest that smoking is a causal factor for ulcer perforation and accounts for a major part of ulcer perforations in the population aged less than 75 years.
(GUT 1997;41:177-180)

Keywords: peptic ulcer perforation;  gastric ulcer;  duodenal ulcer;  smoking;  NSAID;  risk factor