Abstract
Peptic ulcer predicts gastric cancer. It is controversial if peptic ulcers predict other gastrointestinal cancers, potentially related to Helicobacter pylori or shared lifestyle factors. We hypothesized that gastric and duodenal ulcers may have different impact on the risk of gastrointestinal cancers. In a nationwide cohort study using Danish medical databases 1994–2013, we quantified the risk of gastric and other gastrointestinal cancers among patients with duodenal ulcers (dominantly H. pylori‐related) and gastric ulcers (dominantly lifestyle‐related) compared with the general population. We started follow‐up 1‐year after ulcer diagnosis to avoid detection bias and calculated absolute risks of cancer and standardized incidence ratios (SIRs). We identified 54,565 patients with gastric ulcers and 38,576 patients with duodenal ulcers. Patient characteristics were similar in the two cohorts. The 1–5‐year risk of any gastrointestinal cancer was slightly higher for gastric ulcers patients (2.1%) than for duodenal ulcers patients (2.0%), and SIRs were 1.38 (95% CI: 1.31–1.44) and 1.30 (95% CI: 1.23–1.37), respectively. The SIR of gastric cancer was higher among patients with gastric ulcer than duodenal ulcer (1.92 vs. 1.38), while the SIRs for other gastrointestinal cancers were similar (1.33 vs. 1.29). Compared with gastric ulcer patients, duodenal ulcer patients were at lower risk of smoking‐ and alcohol‐related gastrointestinal cancers. The risk of nongastric gastrointestinal cancers is increased both for patients with gastric ulcers and with duodenal ulcers, but absolute risks are low. H. pylori may be less important for the development of nongastric gastrointestinal cancer than hypothesized.
Highlights
Peptic ulcer disease (PUD) is a common condition, leading to incident hospital contact in 2 per 1000 persons annually [1]
Site-specific absolute cancer risks were low in both PUD cohorts, and the direction of the associations with both gastric and other GI cancers was consistent among patients with the two ulcer types
H. pylori-related) had a lower risk of several cancers than gastric ulcer patients, we question if H. pylori is an important player in the development of nongastric GI cancer
Summary
Peptic ulcer disease (PUD) is a common condition, leading to incident hospital contact in 2 per 1000 persons annually [1]. Helicobacter pylori (H. pylori) colonizes both duodenal ulcers (approximately 80% [2]) and to a lesser degree gastric ulcers (approximately 50% [3]), and has been associated with increased risk of gastric cancer [4, 5]. There is growing interest in a possible link between H. pylori infection, peptic ulcer, and risk of nongastric GI cancers [7,8,9]. Several lifestyle factors are associated with an increased risk of PUD and affect cancer risk. Alcohol overuse may increase risk of PUD, as indicated by the strong association between liver cirrhosis and pancreatic disease and increased PUD incidence [15]. Alcohol overuse is associated with several GI cancers [10, 14]
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