title: Smoking and ulcer perforation.
abstract: 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.
  
  
  OBJECTIVE
  To assess the role of smoking in ulcer perforation.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Haukeland University Hospital, Bergen, Norway.
authors.forename: C
authors.initials: C
authors.lastname: Svanes
authors.forename: J A
authors.initials: JA
authors.lastname: Søreide
authors.forename: A
authors.initials: A
authors.lastname: Skarstein
authors.forename: B T
authors.initials: BT
authors.lastname: Fevang
authors.forename: P
authors.initials: P
authors.lastname: Bakke
authors.forename: S E
authors.initials: SE
authors.lastname: Vollset
authors.forename: K
authors.initials: K
authors.lastname: Svanes
authors.forename: O
authors.initials: O
authors.lastname: Søoreide
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D004381:Duodenal Ulcer / Q000150:complications* / Q000209:etiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010439:Peptic Ulcer Perforation / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D013276:Stomach Ulcer / Q000150:complications* / Q000209:etiology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal