title: A prospective study of periodontal disease and risk of gastric and duodenal ulcer in male health professionals.
abstract: OBJECTIVE
  Periodontal disease has been associated with higher circulating levels of inflammatory markers and conditions associated with chronic inflammation, including vascular disease, diabetes mellitus, and cancer. Limited data exist on the relationship between periodontal disease and gastric and duodenal ulcer.
  
  
  METHODS
  We conducted a prospective cohort study of 49,120 men in the Health Professionals Follow-up Study, aged 40-75 years at enrollment in 1986. Biennially, we assessed periodontal disease, tooth loss, and other risk factors for gastric and duodenal ulcer. We validated diagnoses of gastric and duodenal ulcer through medical record review. We used Cox proportional hazards modeling, adjusting for potential confounders, to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).
  
  
  RESULTS
  We documented 138 cases of gastric ulcer and 124 cases of duodenal ulcer with available information on Helicobacter pylori status over 24 years of follow-up. After adjustment for risk factors, including smoking and regular use of aspirin and non-steroidal anti-inflammatory drugs, men with periodontal disease with bone loss had a multivariate HR of ulcer of 1.62 (95% CI, 1.24-2.12). Periodontal disease appeared to be associated with a similar risk of developing ulcers that were H. pylori negative (HR 1.75; 95% CI, 1.26-2.43) than H. pylori positive (HR 1.40; 95% CI, 0.87-2.24), as well as ulcers in the stomach (HR 1.75; 95% CI, 1.21-2.53) than ulcers in the duodenum (HR 1.47; 95% CI, 0.98-2.19).
  
  
  CONCLUSIONS
  Periodontal disease is associated with an increased risk of incident gastric and duodenal ulcer. This relationship may be mediated by alterations in the oral and gastrointestinal microbiome and/or systemic inflammatory factors.
authors: Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors: Matthew R
authors: MR
authors: Boylan
authors: Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors: Hamed
authors: H
authors: Khalili
authors: Department of Gastroenterology, Palo Alto Medical Foundation, Mountain View, California, USA.
authors: Edward S
authors: ES
authors: Huang
authors: 1] Division of Epidemiology, Division of Biology and Medicine, Brown University, Providence, Rhode Island, USA [2] School of Public Health, Imperial College London, London, UK.
authors: Dominique S
authors: DS
authors: Michaud
authors: Department of Molecular Genetics, The Forsyth Institute, Cambridge, Massachusetts, USA.
authors: Jacques
authors: J
authors: Izard
authors: 1] Center for Clinical Research and Health Promotion, University of Puerto Rico School of Dental Medicine, San Juan, Puerto Rico [2] Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors: Kaumudi J
authors: KJ
authors: Joshipura
authors: 1] Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA [2] Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors: Andrew T
authors: AT
authors: Chan