Effects of cigarette smoking on healing and remission of duodenal ulcer

Abstract

This study assessed the relationship between smoking and serum acidic markers in patients with duodenal ulcer and the role of smoking in ulcer healing and long-term ulcer remission. Marked elevation of mean serum pepsinogen I levels (mean ± SD, 141.9 ± 41.4 μg/L in smokers versus 103.8 ± 30.9 μg/L in nonsmokers; P < 0.001) and significant correlation of this marker with serum gastrin levels (r = .306, P < 0.05) characterized the duodenal ulcer patients who smoked. However, no difference in Helicobacter pylori infection rates were seen in the smoking and nonsmoking patients. Of those patients who were treated with famotidine, smoking, age, and a larger ulcer crater correlated with a reduced ability to heal the ulcer. The cumulative percentage of patients in remission among the healed nonsmokers at months 1, 3, 6, and 12 after ulcer healing was 90%, 76.7%, 56.5%, and 17%, respectively, whereas the percentage of patients in remission among the healed smokers was 58.6%, 33%, 14.7%, and 3.7%, respectively. The difference between the two groups was statistically significant ( P < 0.001). This study suggests that smoking facilitates acid secretion and interferes with duodenal ulcer healing. Once the ulcer heals, recurrence is likely in smokers who do not receive maintenance therapy.