Additive deleterious effect of smoking on gastroduodenal pathology and clinical course in Helicobacter pylori-positive dyspeptic patients

Background: Cigarette smoking has long been regarded as an important factor in the pathogenesis of peptic ulcer disease. Objective: To investigate whether cigarette smoking has an additive effect on the clinical presentation and course of disease in Helicobacter pylori-p ositive dyspeptic patients. Patients and Methods: The study group comprised 596 consecutive H. pylori-p ositive dyspeptic patients (334 males and 262 females, mean age 50.6, range 12-81 years). Following upper gastrointestinal endoscopy, patients were su bdivided by diagnosis as follows: Non-ulcer patient group (n=312: gastritis 193, duodenitis 119), gastric ulcer (n=19), and duodenal ulcer (n=265). H. pylori infection was confirmed by histology and/or rapid urease test. In a ddition, 244 patients had a positive C-14-urea breath test prior to antimic robial treatment. The patients' medical history and smoking habits were obt ained using a detailed questionnaire completed by the patients and their re ferring physicians. Results: There were 337 non-smoking patients, 148 current smokers and 111 p ast smokers. Gastric and duodenal ulcers were significantly less prevalent in nonsmokers than in current or past smokers (gastric 1.8%, 4.1%, 6.3%; du odenal 39.8%, 50%, 51.4%, respectively) (P<0.05). The incidence of gastroin testinal bleeding was significantly lower in non-smokers than in current or past smokers (7.1%, 8.1% and 20.7%, respectively) (P<0.05). Bacterial dens ity, as assessed by the UBT value in 244 patients, was higher in non-smoker s (mean 352.3+/-273 units) than in past smokers (mean 320.8+/-199) or curre nt-smokers (mean 229.9+/-162) (P<0.05). Logistic regression analysis reveal ed that male gender, current smoking, and immigration from developing count ries were all significant independent risks for developing duodenal ulcer, while only past smoking was associated with a higher rate of upper gastroin testinal bleeding in the past. Conclusions: In H. pylori-positive dyspeptic patients, current smoking as w ell as male gender and immigration from developing countries are associated with an increased risk for duodenal ulcer. This effect does not seem to be related to the bacterial density or increased urease activity of H. pylori organisms.