Meta-analysis of Risk Factors for Peptic Ulcer

Abstract

Attributable risk models describe the role of three risk factors for peptic ulcer and related serious upper gastrointestinal (GI) events. The factors-nonsteroidal antiinflammatory drugs (NSAIDs), Helicobacter pylori, and cigarette smoking-have been identified as major risk factors for peptic ulcer in numerous clinical and epidemiologic studies. Overall risk ratios for each risk factor were based on meta-analyses of English-language studies of risk for peptic ulcer-related GI events. Exposure estimates for factors used data from North American populations. Summary risk and exposure values were computed for the general population, males and females separately, and the elderly. Hypothetical models of multiple factor attributable risks were developed using population attributable risk percent calculated from these summary values. General population attributable risk percent were as follows: 24%, NSAIDs; 48%, H. pylori; and 23%, cigarette smoking. Based on these numbers, the "no interaction" attributable risk model estimates that 95% of total peptic ulcer related risk is attributable to these factors in the general population. The "interaction" model attributes 89% of cases to these risk factors: 24%, NSAIDs alone; 31%, H. pylori alone; 34%, H. pylori/smoking combined. Between 89% and 95% of peptic ulcer-related serious upper GI events may be attributed to NSAID use, H. pylori infection, and cigarette smoking.

The cost-effectiveness of screening for Helicobacter pylori to reduce mortality and morbidity from gastric cancer and peptic ulcer disease: a discrete-event simulation model

“…Nine studies were identified, six of which were included in a meta-analysis by Kurata and Nogawa, 46 who calculated an overall relative risk for peptic ulcer associated with H. pylori of 3.3.…”

“…In our base case, the probability of acquiring peptic ulcer complications or dying from ulcers was not affected by H. pylori status over and above a threefold risk of developing a peptic ulcer. 46 A recent meta-analysis has shown that the relationship between H. pylori and NSAIDs and peptic ulcer disease is complex. Both of the former are strong independent determinants of ulcer risk, with an odds ratio of nearly 20; in the presence of the other factor each increases the risk by an additional factor of 3.5.…”

Use of tobacco products and gastrointestinal morbidity: an endoscopic population-based study (the Kalixanda study)

“…The nicotine intake is usually higher than in smokers, and a great deal of tobacco juice contaminated saliva is swallowed during use. In a Swedish cross-sectional study of symptoms in 130,000 construction workers, smokers reported "ulcer-like" dyspepsia three times as often 5 as the non tobacco users, while snus users reported significantly fewer symptoms than both smokers and non tobacco users [10].It has been shown both in studies on patients and in population-based studies that smoking is a risk factor for peptic ulcer disease (PUD) [8,11], but there are no data concerning snus on this issue. Data from the US show that cigarette smokers have a markedly increased risk for gastric cancer and that use of more than one tobacco product increases the risk in men [12].…”

“…It has been shown both in studies on patients and in population-based studies that smoking is a risk factor for peptic ulcer disease (PUD) [8,11], but there are no data concerning snus on this issue. Data from the US show that cigarette smokers have a markedly increased risk for gastric cancer and that use of more than one tobacco product increases the risk in men [12].…”

“…Epidemiological and experimental studies have shown that smoking leads to harmful effects on the gastric mucosa [6][7][8][9]. The mechanisms, however, are unclear and the effects might be mediated by inhaled nicotine, as well as by other chemical contents of tobacco.…”