Background/aims: To elucidate the relationship among disparate ulcer risk factors in 3 subtypes of gastric ulcer.
Methodology: One hundred and fifty-nine age-matched controls, 30 patients with ulcer craters in the gastric body (GU-I), 55 with coexistent gastroduodenal ulcer (GU-II), and 69 with ulcer craters in the prepyloric region (GU-III) were examined for potential risk factors. These included cigarette smoking, nonsteroidal anti-inflammatory drug use, Helicobacter pylori infection, gender and ABO blood group. Using multiple logistic regression analysis, Odds ratios of relevant risk factors associated with different subtypes of gastric ulcer were reported.
Results: Among all gastric ulcer subsets, cigarette smoking, nonsteroidal anti-inflammatory drugs use and H. pylori infection were independent ulcer risk factors. For GU-I, smoking (OR: 3.98; 95% CI: 1.44-11.0) and nonsteroidal anti-inflammatory drugs use (OR: 4.33; 95% CI: 1.10-17.1) raised the likelihood of ulceration. For GU-II and GU-III, smoking, nonsteroidal anti-inflammatory drug use and H. pylori infection were identified as risk factors. H. pylori infection carried the strongest association with gastroduodenal ulcer (OR: 9.29; 95% CI: 3.11-27.7) in GU-II, and nonsteroidal anti-inflammatory drug use generated the highest possibility of GU-III (OR: 11.3; 95% CI: 3.49-36.5). Nonsteroidal anti-inflammatory drug use also markedly raised the likelihood of multiple gastric ulcers (OR: 17.0; 95% CI: 4.21-68.9).
Conclusions: Stratification analysis showed differential influences of risk factors on separate subtypes of gastric ulcer. These data support the hypothesis that peptic ulcer disease is heterogeneous in etiology and pathogenesis.