Possible Relationship between Smoking and Peptic Ulcer

Abstract

EPIDEMIOLOGICAL studies have shown that the incidence of peptic ulcer is higher among smokers than non-smokers¹ No reason for this association has been found. Since personality factors seem to play an important role in this disease, it could be argued that both the development of an ulcer and the habit of smoking heavily result from the same psychological traits and are therefore not related. Recently, however, Jacobson et al. demonstrated that nicotine markedly reduced secretion of water and bicarbonate from the pancreas by inhibiting the stimulating effect of secretin^2,3. Since gastric acid is normally neutralized in the duodenum by pancreatic juice and, to a lesser extent, by bile, it was thought that nicotine might predispose to ulcer formation by preventing such neutralization. We have tested this possibility in rats treated with a combination of two gastric secretogogues (substances which stimulate secretion of gastric juice), pentagastrin and carbachol, which had been found to produce duodenal ulcers⁴. We have reported that when these secretogogues were administered in small doses known to produce an ulcer incidence of only 36%, the addition of nicotine raised the incidence to 90%, and the ulcers were multiple and very severe⁵. Nicotine, given alone, was without effect. This result indicated that nicotine sensitized the duodenum to the ulcerogenic effects of the two secretogogues used.