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J R Soc Med. 1988 February; 81(2): 92–94.
PMCID: PMC1291474

Perforated duodenal ulcer and cigarette smoking.


Whilst the association between smoking and peptic ulceration has been reported previously, the relationship between smoking and the complications of ulcers, such as perforation, bleeding or acute painful exacerbation, has not been examined. In a retrospective study comparing 275 emergency admissions for peptic ulcer with 275 controls, cigarette smoking was significantly more common only in those with a perforated duodenal ulcer. Of 128 patients with perforated duodenal ulcers, 110 (86%) were cigarette smokers compared with 65 (51%) of the 128 matched controls (X2, P less than 0.01). Cigarette smoking in patients with bleeding or acutely exacerbated ulcers was not significantly more common than in controls. These findings strongly suggest a particular association between smoking and perforated duodenal ulcer.

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Selected References

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  • DOLL R, JONES FA, PYGOTT F. Effect of smoking on the production and maintenance of gastric and duodenal ulcers. Lancet. 1958 Mar 29;1(7022):657–662. [PubMed]
  • Herrmann RP, Piper DW. Factors influencing the healing rate of chronic gastric ulcer. Am J Dig Dis. 1973 Jan;18(1):1–6. [PubMed]
  • Peterson WL, Sturdevant RA, Frankl HD, Richardson CT, Isenberg JI, Elashoff JD, Sones JQ, Gross RA, McCallum RW, Fordtran JS. Healing of duodenal ulcer with an antacid regimen. N Engl J Med. 1977 Aug 18;297(7):341–345. [PubMed]
  • Gugler R, Rohner HG, Kratochvil P, Brandstätter G, Schmitz H. Effect of smoking on duodenal ulcer healing with cimetidine and oxmetidine. Gut. 1982 Oct;23(10):866–871. [PMC free article] [PubMed]
  • Korman MG, Hansky J, Merrett AC, Schmidt GT. Ranitidine in duodenal ulcer: incidence of healing and effect of smoking. Dig Dis Sci. 1982 Aug;27(8):712–715. [PubMed]
  • Protell RL, Gilbert DA, Silverstein FE, Jensen DM, Hulett FM, Auth DC. Computer-assisted electrocoagulation: bipolar vs. monopolar in the treatment of experimental canine gastric ulcer bleeding. Gastroenterology. 1981 Mar;80(3):451–455. [PubMed]
  • Massarrat S, Eisenmann A. Factors affecting the healing rate of duodenal and pyloric ulcers with low-dose antacid treatment. Gut. 1981 Feb;22(2):97–102. [PMC free article] [PubMed]
  • Piper DW, Greig M, Coupland GA, Hobbin E, Shinners J. Factors relevant to the prognosis of chronic gastric ulcer. Gut. 1975 Sep;16(9):714–718. [PMC free article] [PubMed]
  • Piper DW, Shinners J, Greig M, Thomas J, Waller SL. Effect of ulcer healing on the prognosis of chronic gastric uler. Four-year follow-up. Gut. 1978 May;19(5):419–424. [PMC free article] [PubMed]
  • Ippoliti A, Elashoff J, Valenzuela J, Cano R, Frankl H, Samloff M, Koretz R. Recurrent ulcer after successful treatment with cimetidine or antacid. Gastroenterology. 1983 Oct;85(4):875–880. [PubMed]
  • Korman MG, Hansky J, Eaves ER, Schmidt GT. Influence of cigarette smoking on healing and relapse in duodenal ulcer disease. Gastroenterology. 1983 Oct;85(4):871–874. [PubMed]
  • Sontag S, Graham DY, Belsito A, Weiss J, Farley A, Grunt R, Cohen N, Kinnear D, Davis W, Archambault A, et al. Cimetidine, cigarette smoking, and recurrence of duodenal ulcer. N Engl J Med. 1984 Sep 13;311(11):689–693. [PubMed]
  • Hull DH, Beale PJ. Cigarette smoking and duodenal ulcer. Gut. 1985 Dec;26(12):1333–1337. [PMC free article] [PubMed]
  • Ainley CC, Forgacs IC, Keeling PW, Thompson RP. Outpatient endoscopic survey of smoking and peptic ulcer. Gut. 1986 Jun;27(6):648–651. [PMC free article] [PubMed]
  • Bock OA. Alcohol, aspirin, depression, smoking, stress and the patient with a gastric ulcer. S Afr Med J. 1976 Feb 28;50(9):293–297. [PubMed]
  • Jorgensen TG, Gyntelberg F. Occurence of peptic ulcer disease in Copenhagen males age 40-59. Life incidence and one-year incidence correlated to environmental factors, life habits, physical factors, and concomitant disease. Dan Med Bull. 1976 Feb;23(1):23–28. [PubMed]
  • Friedman GD, Siegelaub AB, Seltzer CC. Cigarettes, alcohol, coffee and peptic ulcer. N Engl J Med. 1974 Feb 28;290(9):469–473. [PubMed]
  • Paffenbarger RS, Jr, Wing AL, Hyde RT. Chronic disease in former college students; 13. Early precursors of peptic ulcer. Am J Epidemiol. 1974 Oct;100(4):307–315. [PubMed]
  • Jedrychowski W, Popiela T. Association between the occurrence of peptic ulcers and tobacco smoking. Public Health. 1974 May;88(4):195–200. [PubMed]
  • EDWARDS F, McKEOWN T, WHITFIELD AG. Association between smoking and disease in men over sixty. Lancet. 1959 Jan 24;1(7065):196–200. [PubMed]
  • Higgins MW, Kjelsberg M. Characteristics of smokers and nonsmokers in Tecumseh, Michigan. II. The distribution of selected physical measurements and physiologic variables and the prevalence of certain diseases in smokers and nonsmokers. Am J Epidemiol. 1967 Jul;86(1):60–77. [PubMed]
  • Goldbourt U, Medalie JH. Characteristics of smokers, nonsmokers and ex-smokers among 10,000 adult males in Israel. I. Distribution of selected sociodemographic and behavioral variables and the prevalence of disease. Isr J Med Sci. 1975 Nov;11(11):1079–1101. [PubMed]
  • Wormsley KG. Smoking and duodenal ulcer. Gastroenterology. 1978 Jul;75(1):139–142. [PubMed]
  • Sherlock DJ, Holl-Allen RT. Duodenal ulcer perforation whilst on cimetidine therapy. Br J Surg. 1984 Aug;71(8):586–588. [PubMed]
  • Boyd EJ, Wilson JA, Wormsley KG. Smoking impairs therapeutic gastric inhibition. Lancet. 1983 Jan 15;1(8316):95–97. [PubMed]
  • Hetzel DJ, Korman MG, Hansky J, Shearman DJ, Eaves ER, Schmidt GT, Hecker R, Fitch RJ. The influence of smoking on the healing of duodenal ulcer treated with oxmetidine or cimetidine. Aust N Z J Med. 1983 Dec;13(6):587–590. [PubMed]
  • Lam SK, Lam KC, Lai CL, Yeung CK, Yam LY, Wong WS. Treatment of duodenal ulcer with antacid and sulpiride. A double-blind controlled study. Gastroenterology. 1979 Feb;76(2):315–322. [PubMed]
  • Comparison of two doses of cimetidine and placebo in the treatment of duodenal ulcer: a multicentre trial. Gut. 1979 Jan;20(1):68–74. [PMC free article] [PubMed]
  • Ward M, Pollard EJ, Cowen A. Double-blind trial of cimetidine versus tri-potassium di-citrato bismuthate in chronic duodenal ulceration. Med J Aust. 1981 Apr 4;1(7):363–364. [PubMed]
  • Brown P. The influence of smoking on pancreatic function in man. Med J Aust. 1976 Aug 21;2(8):290–293. [PubMed]
  • Mertz DP, Thongbhoubesra T. Wirkung von Nicotin auf die Sürebildung in menschlichen Magen. Med Klin. 1976 Jan 23;71(4):147–155. [PubMed]
  • Murthy SN, Dinoso VP, Jr, Clearfield HR, Chey WY. Simultaneous measurement of basal pancreatic, gastric acid secretion, plasma gastrin, and secretin during smoking. Gastroenterology. 1977 Oct;73(4 Pt 1):758–761. [PubMed]
  • Brown P. The influence of smoking on pancreatic function in man. Med J Aust. 1976 Aug 21;2(8):290–293. [PubMed]
  • Bennett JR. Smoking and the gastrointestinal tract. Gut. 1972 Aug;13(8):658–665. [PMC free article] [PubMed]
  • Thompson JH. Effects of nicotine and tobacco smoke on gastric secretion in rats with gastric fistulas. Am J Dig Dis. 1970 Mar;15(3):209–217. [PubMed]

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