PEPTIC ULCERS AND CROHN’S DISEASE

PEPTIC ULCERSà Peptic Ulcers are sores that form on the lining of the stomach or duodenum.  The sore can cause symptoms from burning pain to vomiting and weight loss.  A peptic ulcer is an open sore in the lining of the stomach or duodenum, the first part of the small intestine⁴⁴. The exact cause of ulcers is not known. A relationship between smoking cigarettes and ulcers, especially duodenal ulcers, does exist. The 1989 Surgeon General's report stated that ulcers are more likely to occur, less likely to heal, and more likely to cause death in smokers than in nonsmokers.

Why is this so? Doctors are not really sure, but smoking does seem to be one of several factors that work together to promote the formation of ulcers.

Stomach acid is important in producing ulcers. Normally, most of this acid is buffered by the food we eat. Most of the unbuffered acid that enters the duodenum is quickly neutralized by sodium bicarbonate, a naturally occurring alkali produced by the pancreas⁴⁴. Some studies show that smoking reduces the bicarbonate produced by the pancreas, interfering with the neutralization of acid in the duodenum. Other studies suggest that chronic cigarette smoking may increase the amount of acid secreted by the stomach.

Whatever causes the link between smoking and ulcers, two points have been repeatedly demonstrated: People who smoke are more likely to develop an ulcer, especially a duodenal ulcer, and ulcers in smokers are less likely to heal quickly in response to otherwise effective treatment. This research tracing the relationship between smoking and ulcers strongly suggests that a person with an ulcer should stop smoking ⁷.  One study tracked people for an average of 13.4 years.  In this time period, 214 cases of incident bleeding and 107 cases of perforated ulcers were found.  This study found that smoking more than 15 cigarettes a day compared to never smoking increased the risk of a perforated ulcer more than three fold⁷.   A second study, which was done in China, found that cigarette smoking is coupled with the initiation and prolongation of gastric ulcers.  Data shows that cigarette smoking increases both the incidence and relapse rate of peptic ulcer disease and also delays healing.  A side note from the study; coupled with alcohol the risk of peptic ulcers is even higher²⁴.    

CROHN’S DISEASEà Crohn's disease causes inflammation deep in the lining of the intestine. The disease, which causes pain and diarrhea, usually affects the small intestine, but it can occur anywhere in the digestive tract. Research shows that current and former smokers have a higher risk of developing Crohn's disease than nonsmokers do. Among people with the disease, smoking is associated with a higher rate of relapse, repeat surgery, and immunosuppressive treatment. In all areas, the risk for women, whether current or former smokers, is slightly higher than for men⁴¹.  A study was conducted in Spain to look at the correlation between smoking and Crohn’s Disease and a total of 103 patients were diagnosed with Crohn's disease in Aragón from 1st February, 1992 to 31st January, 1995. Of these 62 patients (60.2%) with Crohn's disease were smokers, compared with 42 (40.8%) controls. Cigarette smoking is considered a risk factor for Crohn's disease with an increased risk of 3 times the normal risk⁴¹.