SMOKING AND ULCER PERFORATION

Background-The use of ulcerogenic drugs is the only well documented ri sk factor for peptic ulcer perforation, but accounts for only a quarte r 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 smokin g in ulcer perforation. Subjects-A total of 168 consecutive patients w ith 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 whi le adjusting for age and sex. Results-Current smoking increased the ri sk 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% C I 4.9 to 17) and women (OR 11.6, 95% Cf 5.3 to 25), and for gastric (O R 10.5, 95% CI 4.5 to 25) and duodenal (OR 8.6, 95% CI 4.9 to 15.4) ul cer 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 par t of ulcer perforations in the population aged less than 75 years.