Skip to main content
NCBI home page
The Yale Journal of Biology and Medicine logoLink to The Yale Journal of Biology and Medicine
. 1998 Mar-Apr;71(2):91–99.

Helicobacter pylori and smoking: two additive risk factors for organic dyspepsia.

F Halter 1, R Brignoli 1
PMCID: PMC2578888  PMID: 10378354

Abstract

The hopes to distinguish between organic and functional dyspepsia on the grounds of the patient's symptomatology have not been fulfilled due to the low specificity of the so-called sinister symptoms. There is increasing evidence accumulating that Helicobacter pylori status and other environmental factors such as smoking have a higher discriminant power. Studies performed in our laboratories testing H. pylori status on gastric biopsy samples have shown that preselection of patients according to smoking habits and H. pylori status has a higher potential in avoiding unnecessary endoscopies in primary care patients as compared to risk factors based on patient complaints. Out of a total population of 282 primary care patients, one out of 24 endoscopies revealed significant pathology such as peptic ulcer or reflux esophagitis in the non-smokers with a negative H. pylori status, but when both risk factors were positive, the percentage rose to one out of every two patients. These observation have largely been confirmed by recent studies where H. pylori status was prospectively assessed prior to endoscopy by highly specific H. pylori serology or 13C breath test analysis.

Full text

PDF
91

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bateson M. C. Cigarette smoking and Helicobacter pylori infection. Postgrad Med J. 1993 Jan;69(807):41–44. doi: 10.1136/pgmj.69.807.41. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Borody T. J., George L. L., Brandl S., Andrews P., Jankiewicz E., Ostapowicz N. Smoking does not contribute to duodenal ulcer relapse after Helicobacter pylori eradication. Am J Gastroenterol. 1992 Oct;87(10):1390–1393. [PubMed] [Google Scholar]
  3. Brignoli R., Merki H., Miazza B., Beglinger C. Endoskopische Befunde bei freiwilligen und dyspeptischen Patienten. Schweiz Med Wochenschr. 1994 Jul 12;124(27-28):1240–1247. [PubMed] [Google Scholar]
  4. Brignoli R., Watkins P., Halter F. The Omega-Project--a comparison of two diagnostic strategies for risk- and cost-oriented management of dyspepsia. Eur J Gastroenterol Hepatol. 1997 Apr;9(4):337–343. doi: 10.1097/00042737-199704000-00005. [DOI] [PubMed] [Google Scholar]
  5. Chattopadhyay D. K., Greaney M. G., Irvin T. T. Effect of cigarette smoking on the lower oesophageal sphincter. Gut. 1977 Oct;18(10):833–835. doi: 10.1136/gut.18.10.833. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Dennish G. W., Castell D. O. Inhibitory effect of smoking on the lower esophageal sphincter. N Engl J Med. 1971 May 20;284(20):1136–1137. doi: 10.1056/NEJM197105202842007. [DOI] [PubMed] [Google Scholar]
  7. Drossman D. A., Li Z., Andruzzi E., Temple R. D., Talley N. J., Thompson W. G., Whitehead W. E., Janssens J., Funch-Jensen P., Corazziari E. U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci. 1993 Sep;38(9):1569–1580. doi: 10.1007/BF01303162. [DOI] [PubMed] [Google Scholar]
  8. Friedman G. D., Siegelaub A. B., Seltzer C. C. Cigarettes, alcohol, coffee and peptic ulcer. N Engl J Med. 1974 Feb 28;290(9):469–473. doi: 10.1056/NEJM197402282900901. [DOI] [PubMed] [Google Scholar]
  9. Gillies M. A., Skyring A. Gastric and duodenal ulcer. The association between aspirin ingestion, smoking and family history of ulcer. Med J Aust. 1969 Aug 9;2(6):280–285. doi: 10.5694/j.1326-5377.1969.tb105725.x. [DOI] [PubMed] [Google Scholar]
  10. Graham D. Y., Colon-Pagan J., Morse R. S., Johnson T. L., Walsh J. H., McCullough A. J., Marks J. W., Sklar M., Stone R. C., Cagliola A. J. Ulcer recurrence following duodenal ulcer healing with omeprazole, ranitidine, or placebo: a double-blind, multicenter, 6-month study. The Omeprazole Duodenal Ulcer Study Group. Gastroenterology. 1992 Apr;102(4 Pt 1):1289–1294. [PubMed] [Google Scholar]
  11. Gray M. R., Donnelly R. J., Kingsnorth A. N. The role of smoking and alcohol in metaplasia and cancer risk in Barrett's columnar lined oesophagus. Gut. 1993 Jun;34(6):727–731. doi: 10.1136/gut.34.6.727. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Halter F., Brignoli R. Epidemiology of dyspepsia: discriminant value of smoking and Helicobacter pylori status as predictors of peptic lesions in primary care. J Physiol Pharmacol. 1997 Sep;48 (Suppl 4):75–83. [PubMed] [Google Scholar]
  13. Halter F. Dyspepsia and Helicobacter pylori: to endoscope or not to endoscope? The Omega-Study Group. Gastroenterology. 1996 Oct;111(4):1159–1159. doi: 10.1016/s0016-5085(96)70091-4. [DOI] [PubMed] [Google Scholar]
  14. Halter F., Zetterman R. K. Long-term effects of Helicobacter pylori infection on acid and pepsin secretion. Yale J Biol Med. 1996 Jan-Feb;69(1):99–104. [PMC free article] [PubMed] [Google Scholar]
  15. Johannessen T., Petersen H., Kleveland P. M., Dybdahl J. H., Sandvik A. K., Brenna E., Waldum H. The predictive value of history in dyspepsia. Scand J Gastroenterol. 1990 Jul;25(7):689–697. doi: 10.3109/00365529008997594. [DOI] [PubMed] [Google Scholar]
  16. Kjellén G., Tibbling L. Influence of body position, dry and water swallows, smoking, and alcohol on esophageal acid clearing. Scand J Gastroenterol. 1978;13(3):283–288. doi: 10.3109/00365527809179821. [DOI] [PubMed] [Google Scholar]
  17. Klauser A. G., Müller-Lissner S. A. Rauchen und gastrointestinale Funktion. Z Gastroenterol. 1993 Sep;31(9):486–492. [PubMed] [Google Scholar]
  18. Knill-Jones R. P. Geographical differences in the prevalence of dyspepsia. Scand J Gastroenterol Suppl. 1991;182:17–24. doi: 10.3109/00365529109109532. [DOI] [PubMed] [Google Scholar]
  19. Mansi C., Mela G. S., Pasini D., Grosso M., Corti L., Moretti M., Celle G. Patterns of dyspepsia in patients with no clinical evidence of organic diseases. Dig Dis Sci. 1990 Dec;35(12):1452–1458. doi: 10.1007/BF01540561. [DOI] [PubMed] [Google Scholar]
  20. McColl K. E., el-Nujumi A., Murray L., el-Omar E., Gillen D., Dickson A., Kelman A., Hilditch T. E. The Helicobacter pylori breath test: a surrogate marker for peptic ulcer disease in dyspeptic patients. Gut. 1997 Mar;40(3):302–306. doi: 10.1136/gut.40.3.302. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Mittal R. K., Lange R. C., McCallum R. W. Identification and mechanism of delayed esophageal acid clearance in subjects with hiatus hernia. Gastroenterology. 1987 Jan;92(1):130–135. doi: 10.1016/0016-5085(87)90849-3. [DOI] [PubMed] [Google Scholar]
  22. Parente F., Lazzaroni M., Sangaletti O., Baroni S., Bianchi Porro G. Cigarette smoking, gastric acid secretion, and serum pepsinogen I concentrations in duodenal ulcer patients. Gut. 1985 Dec;26(12):1327–1332. doi: 10.1136/gut.26.12.1327. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Patel P., Khulusi S., Mendall M. A., Lloyd R., Jazrawi R., Maxwell J. D., Northfield T. C. Prospective screening of dyspeptic patients by Helicobacter pylori serology. Lancet. 1995 Nov 18;346(8986):1315–1318. doi: 10.1016/s0140-6736(95)92340-3. [DOI] [PubMed] [Google Scholar]
  24. Pelissero A., Sategna-Guidetti C. Epidemiologic aspects of peptic ulcer disease in northern Italy. J Clin Gastroenterol. 1989 Jun;11(3):351–356. [PubMed] [Google Scholar]
  25. Rokkas T., Pursey C., Uzoechina E., Dorrington L., Simmons N. A., Filipe M. I., Sladen G. E. Campylobacter pylori and non-ulcer dyspepsia. Am J Gastroenterol. 1987 Nov;82(11):1149–1152. [PubMed] [Google Scholar]
  26. Schindlbeck N. E., Klauser A. G., Berghammer G., Londong W., Müller-Lissner S. A. Three year follow up of patients with gastrooesophageal reflux disease. Gut. 1992 Aug;33(8):1016–1019. doi: 10.1136/gut.33.8.1016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Sonnenberg A. Cost-benefit analysis of testing for Helicobacter pylori in dyspeptic subjects. Am J Gastroenterol. 1996 Sep;91(9):1773–1777. [PubMed] [Google Scholar]
  28. Sontag S. J., Schnell T. G., Miller T. Q., Nemchausky B., Serlovsky R., O'Connell S., Chejfec G., Seidel U. J., Brand L. The importance of hiatal hernia in reflux esophagitis compared with lower esophageal sphincter pressure or smoking. J Clin Gastroenterol. 1991 Dec;13(6):628–643. doi: 10.1097/00004836-199112000-00006. [DOI] [PubMed] [Google Scholar]
  29. Taha A. S., Angerson W., Nakshabendi I., Beekman H., Morran C., Sturrock R. D., Russell R. I. Gastric and duodenal mucosal blood flow in patients receiving non-steroidal anti-inflammatory drugs--influence of age, smoking, ulceration and Helicobacter pylori. Aliment Pharmacol Ther. 1993 Feb;7(1):41–45. doi: 10.1111/j.1365-2036.1993.tb00067.x. [DOI] [PubMed] [Google Scholar]
  30. Talley N. J., McNeil D., Hayden A., Colreavy C., Piper D. W. Prognosis of chronic unexplained dyspepsia. A prospective study of potential predictor variables in patients with endoscopically diagnosed nonulcer dyspepsia. Gastroenterology. 1987 Apr;92(4):1060–1066. [PubMed] [Google Scholar]
  31. Talley N. J., McNeil D., Piper D. W. Discriminant value of dyspeptic symptoms: a study of the clinical presentation of 221 patients with dyspepsia of unknown cause, peptic ulceration, and cholelithiasis. Gut. 1987 Jan;28(1):40–46. doi: 10.1136/gut.28.1.40. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Werdmuller B. F., Loffeld R. J. Helicobacter pylori infection has no role in the pathogenesis of reflux esophagitis. Dig Dis Sci. 1997 Jan;42(1):103–105. doi: 10.1023/a:1018841222856. [DOI] [PubMed] [Google Scholar]
  33. Wiklund O., Angelin B., Bergman M., Berglund L., Bondjers G., Carlsson A., Lindén T., Miettinen T., Odman B., Olofsson S. O. Pravastatin and gemfibrozil alone and in combination for the treatment of hypercholesterolemia. Am J Med. 1993 Jan;94(1):13–20. doi: 10.1016/0002-9343(93)90114-5. [DOI] [PubMed] [Google Scholar]
  34. Wormsley K. G. Smoking and duodenal ulcer. Gastroenterology. 1978 Jul;75(1):139–142. [PubMed] [Google Scholar]

Articles from The Yale Journal of Biology and Medicine are provided here courtesy of Yale Journal of Biology and Medicine

RESOURCES