Duodenal ulcer risk factors

Raja a YA, Noma T, Warafi TA. Khat chewing is a risk factor for duodenal ulcer. Saudi Med J 2000 21 887-8. 

All NSAIDs have the potential to cause gastric and duodenal ulcers and bleeding through direct (topical) or indirect (systemic) mechanisms. Risk factors for NSAID-associated ulcers and ulcer complications (perforation, gastric outlet obstruction, GI bleeding) include increased age, comorbid medical conditions (e.g., cardiovascular disease), concomitant corticosteroid or anticoagulant therapy, and history of peptic ulcer disease or upper Gl bleeding. 

Chewing khat is said to be a risk factor of duodenal ulceration. (27). 

Raja a YA, Noman TA, al Warafi AK, al Mashraki NA, al Yosofi AM. Khat chewing is a risk factor of duodenal ulcer. East Mediterr Health J 2001 7(3) 568-70. 

Moreover, the meta-analysis clarified another uncertainty whether in NSAID takers H. pylori infection is as important a risk factor for gastric ulcer as it is for duodenal ulcer. A pooled analysis of four studies (75,97-99) showed that H. pylori infection is less closely associated with gastric ulcer than with duodenal ulcer in both NSAID users and non-users, and that while NSAID use has a major role in the development of gastric ulcer, duodenal ulcer is more closely related to H. pylori infection. 

The most common sites of GI injmy are the gastric and duodenal mucosae." The incidence of gastric ulcers with NSAID use is approximately 11% to 13%, and that for duodenal ulcers is 7% to 10%. Serious GI complications associated with NSAIDs, including perforations, gastric outlet obstruction, and GI bleeding, occur in 1.5% to 4% of patients per year. NSAIDs are so widely used that these small percentages translate into substantial morbidity and mortality. " Moreover, the risk increases to 9% per year for patients with the risk factors of advanced age, history of peptic ulcer or GI bleeding, or cardiovascular disease. Consequently, about 16,500 deaths are associated annually with NSAID use in rheumatoid arthritis or OA patients. 

Reynolds JC, Schoen RE, Maislin G, Zangari GG. Risk factors for delayed healing of duodenal ulcers treated with famotidine and ranitidine. Am J Gastroenterol ( 994) 89, 571-80. 

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