nonsmokers, with a trend of increased risk with increased number of cigarettes smoked. In Israel, the lifetime prevalence of PUD is 89/1000 men (37), similar to that in the United States. Smokers or ex-smokers had a prevalence

cigarettes smoked. In Israel, the lifetime prevalence of PUD is 89/1000 men (37), similar to that in the United States. Smokers or ex-smokers had a prevalence of PUD (primarily duodenal) of 10.2 percent compared to 6.2 percent of nonsmokers (25). These differences were highly significant. Medalie, et al. made the interesting observation that as the smoking habits of first-generation Israelis of European descent increased, so did the prevalence of duodenal ulcer in this group (97’). Thus, when the question, “Do cigarette smokers have more peptic ulcers than nonsmokers?’ is asked, results are strikingly consistent. Table 1 lists the six studies which investigated this problem (22, 23, 25, 28,31, /I) with a summary of their characteristics and results. In each of the studies there was an increased prevalence of PUD in cigarette smokers compared to nonsmokers. Despite the fact that these studies were done at different times and in four different countries, the ratios for men are very similar, the median being 1.7 and the mean 1.9. The ratios for women are similar with the exception of the Polish study, in which very few women smoked. The ratios for ex-smokers (not shown) are also consistently greater than 1.0. In addition, the majority of the studies provided evidence of increased frequency of peptic ulcer with increases in the amount smoked.