Campylobacter pylori, NSAIDS, and smoking: risk factors for peptic ulcer disease

Campylobacter pylori, nonsteroidal anti-inflammatory drugs, and smoking are associated with ulcer disease. To define further the role of these factors in ulcer disease, one hundred seven subjects presenting for endoscopy were tested for specific IgG and IgA antibodies to C. pylori, and questioned about nonsteroidal use and smoking. Sixty were dyspeptic patients, 28 were disease controls, and 19 were healthy asymptomatic volunteers. Considering all subjects, 81% (87/107) were either taking nonsteroidals or had antibody to C. pylori, and 32% of these (28/87) had an ulcer. Nineteen percent (20/107) were neither taking nonsteroidals nor had antibody to C. pylori, and none of these had an ulcer, p less than 0.01. Smokers, 41% (11/27), were more likely to have an ulcer than nonsmokers, 20% (16/80), p less than 0.05, but only because of the increased prevalence of ulcers in smokers who also had C. pylori, 73% (11/15) versus 27% (12/45) of nonsmokers with C. pylori, p less than 0.01. The use of nonsteroidals and antibody to C. pylori identify people at risk for ulcers. Smoking increases this risk in subjects with C. pylori. Absence of a history of nonsteroidal use and antibody to C. pylori identify individuals with a low probability of ulcer disease.