Smoking and ulcer perforation.

BACKGROUND: The 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. AIM: To assess the role of smoking in ulcer perforation. SUBJECTS: A total of 168 consecutive patients with gastroduodenal ulcer perforation and 4469 control subjects from a population based health survey. METHODS: The association between ulcer perforation and smoking habits was analysed by logistic regression while adjusting for age and sex. RESULTS: Current 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). CONCLUSION: Our 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.

Mortality from dementia among gastroduodenal ulcer patients.

STUDY OBJECTIVE: The aim was to examine whether a high intake of aluminium containing antacids is a risk for Alzheimer's disease. DESIGN: The mortality from dementia (1970-87), coded from death certificates as underlying or contributory cause of death, was compared with national rates in a cohort of patients who had surgery for gastroduodenal ulcer disease between 1911 and 1978. SETTING: Patient data were obtained from patient records from major hospitals in western Norway. PARTICIPANTS: 4179 patients were identified who met the study criteria, which included having had a documented stomach operation, having a reliably identifiable personal number, and being alive on Jan 1, 1970. MEASUREMENTS AND MAIN RESULTS: The standardised mortality ratio for dementia was 1.10 (95% CI 0.85-1.40, n = 64) for all patients, while for patients operated on in the period 1967-78 it was 1.25 (95% CI 0.66-2.13, n = 13). CONCLUSIONS: As the majority of patients operated on after 1963 have probably been heavy consumers of aluminium containing antacids, the study provides meager evidence that a high intake of aluminium is an important risk factor for Alzheimer's disease, the major cause of dementia. However, the possibility of a raised mortality from Alzheimer's disease cannot be ruled out due to probable misclassification both in diagnosis and exposure. In addition, the observation period may have been too short to detect an effect since the latent period for Alzheimer's disease may be very long.

The risk of cancer at all sites following gastric operation for benign disease. A cohort study of 4,224 patients.

This report represents the results of a historical cohort analysis of 3,360 males and 864 females who had a gastric resection or gastroenterostomy for benign disease between 1990 and 1969. Within the period 1970 to 1988 the cohort was cross-checked with the data files at the Cancer Registry of Norway to identify the patients in whom cancer had been diagnosed. When analyzed according to cancer sites, increased risk was recorded for the oropharynx, stomach, colon, pancreas, liver, biliary tract, larynx, lungs, urinary bladder and non--melanomatous cancers of the skin in males. In females, increased risk was only observed for the oropharynx, but was close to a statistically significant level also for cancer of the stomach. A lower number of tumors of the central nervous system than expected was observed in both males and females. The increased risk of cancer of the lungs, larynx and urinary bladder in males can be regarded as evidence of the high prevalence of smokers in the cohort. We suggest that the increased risk of cancer of digestive organs is mainly related to life-style factors, particularly tobacco-specific nitrosamines whose effect is enhanced by surgical sequelae.