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October 26, 1984

Gastroenterology and Hepatology

JAMA. 1984;252(16):2181-2188. doi:10.1001/jama.1984.03350160049016

Analysis of the factors affecting the healing and the relapse of duodenal and gastric ulcers has indicated that cigarette smoking is the most important adverse factor.1-3 Smoking of more than one half of a pack of cigarettes daily halves the rate of healing at four weeks and doubles the frequency of relapses within one year for patients with duodenal ulcers. Smoking fewer cigarettes is comparable with nonsmoking in its effect on healing. Alcoholic beverages are inimical also; even beer, wine, and 5% ethanol are potent stimulants of acid secretion.4 Calcium is also an acid secretogogue,5 suggesting that milk and calcium-containing antacids are to be avoided. However, infusion of strong acids into the stomach usually does not reproduce pain in patients with active duodenal ulcers,6 so that adverse effects on healing cannot be assumed simply because the stimulation of acid is demonstrated. Other factors that impair healing