Smoking peptic ulcer disease

O Patients with peptic ulcer disease should avoid exposure to factors known to worsen the disease, exacerbate symptoms, or lead to ulcer recurrence [e.g., non-steroidal anti-inflammatory drug (NSAID) use or cigarette smoking]. 

The patient is taking glyburide for non-insulin-dependent diabetes mellitus and has been treated in the past for peptic ulcer disease with ranitidine and omeprazole. He has a history of allergy to various types of pollen but reports no allergies to drugs. He reports moderate consumption of alcohol and smoking 2 packs of cigarettes per day. 

Answer Peptic ulcer disease is most frequently secondary to either Helicobacter pylori infection or use of NSAIDs. The patient does admit to NSAID use (naproxen), but should also be checked for concomitant H. pylori infection at time of endoscopy or by a serology test. If the patient was found to have H. pylori, an appropriate eradication regimen should be prescribed. The patient should also be counseled to avoid NSAIDs. The patient should be prescribed a proton pump inhibitor for 8 weeks to heal the ulcer. A repeat endoscopy should be done at that time to document ulcer healing and rule out gastric cancer. In addition, the patient should be counseled to stop smoking, which is a risk factor for more severe peptic ulcer disease. 

Martin DF, Montgomery E, Dobek AS, Patrissi GA, Peura DA. Campylobacter pylori, NSAIDS, and smoking risk factors for peptic ulcer disease. Am J Gastroenterol 1989 84(10) 1268-72. 

Patients with peptic ulcer disease should reduce psychological stress, cigarette smoking, and nonsteroidal antiinflammatory drug (NSAID) use, and should avoid foods and beverages that exacerbate ulcer symptoms. 

Patients with peptic ulcer disease who develop recurrent ulcer signs or symptoms of Cl bleeding or perforation should be referred to a specialist. Assess reasons for therapeutic failure, including noncompliance to the drug regimen, antibiotic resistance (HPeradication), heavy smoking, NSAID use, and the need for HP eradication in a patient on conventional antiulcer medications. 

Peptic ulcer disease is erosion of gastric or duodenal mucosa by acid and pepsin. It is exacerbated by stress, alcohol, cigarette smoking, some foods and aspirin-like drugs. 

Relative (1) patients with serious gastrointestinal events and other risk factors known to be associated with peptic ulcer disease such as alcoholism, smoking, etc. (2) Elderly and debilitated patients who cannot tolerate ulceration or bleeding well. (3) Patients with bronchospastic reactivity (e.g. asthma), nasal polyps, or those with a history of angioedema can have an anaphylactoid reaction after ibuprofen. (4) Patients with advanced renal disease should be monitored closely during the treatment of ibuprofen. 

Peptic ulcer disease is one common illness that affects more than 6 million persons in the United States each year (Sandler et al. 2001) and is strongly linked wifii increased rate of cigarette smoking, alcohol intake, psychological stress, regular use of aspirin, and prolonged use of steroids. Infection with Helicobacter pylori also substantially increases the risk for peptic ulcer and its complications (Papatheodo-ridis et al. 2006). Essential oil of Cinnamomum zeylanicum also... 

Clearly, the addictive power of cigarettes is directly related to their nicotine content. It is not known to what extent nicotine per se contributes to the other well-documented adverse effects of chronic tobacco use. It appears highly probable that nicotine contributes to the increased risk of vascular disease and sudden coronary death associated with smoking. Also, nicotine probably contributes to the high incidence of ulcer recurrences in smokers with peptic ulcer. 

Smoking is especially harmful to diabetics who are already at an increased risk of cardiovascular disease, stroke, and kidney disease. The habit also negatively affects joints and interferes with the healing of wounds. Healing of fractures is delayed because smoking impairs the formation of new bone. Smokers are more likely to develop degenerative disorders and injuries of the spine. The risk for peptic ulcers is increased. Smoking also may upset thyroid function. 

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