Smoking and hyperpepsinogenemia are associated with increased risk for duodenal ulcer in Helicobacter pylori-infected patients

Background: Although Helicobacter pylori has been established as a major etiologic factor of chronic gastritis and makes an important contribution to peptic ulceration, the reason why H. pylori causes different gastroduodenal diseases in different people is at present not clear. Goals: The aim of this study is to identify risk factors associated with duodenal ulcers in H. pylori-infected patients in a multivariate context. Study: Demographic data, personal habits, stressful life events, psychologic distress, severity of histology of antral mucosa, and serum pepsinogen I concentrations were studied in 54 consecutive dyspeptic patients with duodenal ulcers and 40 patients with functional dyspepsia. Results: As compared with functional dyspepsia patients, duodenal ulcer patients had more smokers (53.7% vs. 12.5%, P = 0.000), higher pepsinogen I levels (median 96.0 vs. 74.5 ng/mL; P = 0.002), more males (74.1% vs. 42.5%, P = 0.004), more single (22.6% vs. 7.5%, P < 0.05), and less in religion belief (44% vs. 70%, P < 0.05). Only smoking remained significant on multivariate analysis (odds ratio = 10.86, 95% CI = 2.92-40.41, P < 0.001). Among non-smokers, only serum pepsinogen I level was found higher in duodenal ulcer patients as compared with functional dyspepsia patients (88 vs. 71, P < 0.05). Conclusions: Smoking and hyperpepsinogenemia are associated with increased risk for duodenal ulcer in H. pylori-infected patients.