Date of this Version
2014 the American College of Gastroenterology
Periodontal disease is characterized by microbial shifts within the oral cavity and chronic inflammation of the gingival tissue, and can lead to tooth loss. Several studies support an association between periodontal disease and risk of chronic systemic conditions, including vascular disease, chronic obstructive pulmonary disease, diabetes mellitus, and cancer, including gastric adenocarcinoma.1–15 These associations may be mediated by systemic inflammation, the immune response to periodontal infection, or direct invasion by pathogens. Previous studies of periodontal disease and risk of peptic ulcer have been limited by cross-sectional design, diagnoses that were not confirmed by medical record review, and a lack of information on key confounders, including smoking, aspirin and non-steroidal anti-inflammatory drug (NSAID) use, socioeconomic status, and Helicobacter pylori infection status.16–19
To address these limitations, we investigated the relationship between periodontal disease and the risk of gastric and duodenal ulcer among men enrolled in the Health Professionals Follow-up Study (HPFS), a large cohort of US male health professionals who provided updated data on oral health and other risk factors, including smoking and aspirin and NSAID use, over 24 total years of follow-up. This population is relatively homogenous in terms of socioeconomic and educational status, which minimizes the potential influence of confounding lifestyle factors.