{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T19:07:11Z","timestamp":1772824031884,"version":"3.50.1"},"reference-count":31,"publisher":"BMJ","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Epidemiol Community Health"],"published-print":{"date-parts":[[1994,4]]},"abstract":"<jats:p>STUDY OBJECTIVE--To analyse simultaneously the effect of several risk factors for peptic ulcer. DESIGN--Cohort study where all patients with new or incident peptic ulcers in a well defined population were registered for a seven year period. The follow up started with a comprehensive health survey including a questionnaire on diet, lifestyle, psychological and social conditions, and health. Relative risks, both sex specific and separate, for gastric and duodenal ulcers were estimated from proportional hazard regression analysis. SETTING--A population based survey conducted in the municipality of Troms\u00f8, northern Norway. PARTICIPANTS--In 1980, a total of 21,440 men and women, aged 20 to 54 years and 20 to 49 years respectively, were invited to participate. A total of 14,667 people attended and returned the questionnaire. MAIN RESULTS--A total of 328 people had their first peptic ulcer in the follow up period. Age, cigarette smoking, first degree relatives with peptic ulcer, and low educational level were shared risk factors for peptic ulcer in both men and women. In men, frequent upper respiratory infections increased the risk of gastric ulcer and drinking a great deal of milk increased the risk of duodenal ulcer. None of the other dietary variables, including coffee and alcohol consumption, contributed significantly to the risk. Use of analgesics was not a risk factor, and none of the psychological indicators analysed carried any significant risk. CONCLUSIONS--Age, inheritance, and cigarette smoking are all important risk factors for peptic ulcer. The increased risk associated with low educational background indicate that social strains, comprising lifestyle and diet habits, are part of the multifactorial aetiology of peptic ulcer. No support was found for the assumption that peptic ulcer disease is a psychosomatic disorder. This study did not support the view that duodenal and gastric ulcers have different aetiologies-rather it showed a similarity in risk patterns.<\/jats:p>","DOI":"10.1136\/jech.48.2.156","type":"journal-article","created":{"date-parts":[[2008,11,12]],"date-time":"2008-11-12T15:10:54Z","timestamp":1226502654000},"page":"156-160","source":"Crossref","is-referenced-by-count":33,"title":["Aetiology of peptic ulcer: a prospective population study in Norway."],"prefix":"10.1136","volume":"48","author":[{"given":"R","family":"Johnsen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"O H","family":"F\u00f8rde","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B","family":"Straume","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P G","family":"Burhol","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1994,4,1]]},"reference":[{"key":"ref_1","first-page":"15","article-title":"Civilisation and peptic ulcer","volume":"1","author":"Susser, M.; Stein, Z.","year":"1962","unstructured":"Susser M, Stein Z. Civilisation and peptic ulcer. Lancet 1962;i:1 15-9.","journal-title":"Lancet"},{"key":"ref_2","first-page":"101","article-title":"Life events and chronic duodenal ulcer: a case-control study","volume":"22","author":"Piper, D.W.; McIntosh, J.H.; Ariotti, D.E.; Calogiuri, J.W.; Brown, R.W.; Shy, C.M.","year":"1981","unstructured":"Piper DW, McIntosh JH, Ariotti DE, Calogiuri JW, Brown RW, Shy CM. Life events and chronic duodenal ulcer: a case-control study. Gut 1981;22:101 1-7.","journal-title":"Gut"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1017\/S0033291700009193","article-title":"Psychological correlates of gastric and duodenal ulcer disease","volume":"16","author":"Tennant, C.; Gouldston, K.; Langeluddecke, P.","year":"1986","unstructured":"Tennant C, Gouldston K, Langeluddecke P. Psychological correlates of gastric and duodenal ulcer disease. Psychol Med 1986;16:365-71.","journal-title":"Psychol Med"},{"key":"ref_4","first-page":"135","article-title":"Hereditary factors in peptic ulcer","volume":"1","author":"Doll, R.; Buch, J.","year":"1959","unstructured":"Doll R, Buch J. Hereditary factors in peptic ulcer. Annals of Eugenics 1959;1S:135-46.","journal-title":"Annals of Eugenics"},{"key":"ref_5","first-page":"205","article-title":"Peptic ulcer in twins. A study in personality, heredity and environment","volume":"44","author":"Eberhard, G.","year":"1968","unstructured":"Eberhard G. Peptic ulcer in twins. A study in personality, heredity and environment. Acta Psychiatr Scand 1968;44(suppl 205):55-9.","journal-title":"Acta Psychiatr Scand"},{"issue":"10","key":"ref_6","first-page":"25","volume-title":"The genetics of peptic ulcer","volume":"1","author":"Ellis, A.","year":"1985","unstructured":"Ellis A. The genetics of peptic ulcer. Scand]7 Gastroenterol 1985;20(suppl 1 10):25-7."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1056\/NEJM198409133111108","article-title":"Smoking and ulcers - time to quit","volume":"311","author":"McCarthy, D.M.","year":"1984","unstructured":"McCarthy DM. Smoking and ulcers - time to quit. N EnglJ7 Med 1984;311:726-7.","journal-title":"N EnglJ7 Med"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/0016-5085(81)90001-9","article-title":"Analgesic ingestion and chronic peptic ulcer","volume":"80","author":"Piper, D.W.; McIntosh, J.H.; Ariotti, D.E.; Fenton, B.H.; Mac-Lennan, R.","year":"1981","unstructured":"Piper DW, McIntosh JH, Ariotti DE, Fenton BH, Mac-Lennan R. Analgesic ingestion and chronic peptic ulcer. Gastroenterology 1981;80:427-32.","journal-title":"Gastroenterology"},{"key":"ref_9","first-page":"1015","article-title":"Smoking, alcohol, analgesics, and chronic duodenal ulcer. A controlled study of habits before first symptoms and before diagnosis","volume":"19","author":"Piper, D.W.; Nasiry, R.; McIntosh, J.; Shy, C.M.; Pierce, J.; Byth, K.","year":"1984","unstructured":"Piper DW, Nasiry R, McIntosh J, Shy CM, Pierce J, Byth K. Smoking, alcohol, analgesics, and chronic duodenal ulcer. A controlled study of habits before first symptoms and before diagnosis. Scand Gastroenterol 1984;19:1015-21.","journal-title":"Scand Gastroenterol"},{"issue":"1976","key":"ref_10","first-page":"9","article-title":"Epidemiology of peptic ulcer. Report of a conference","volume":"7","author":"Sturdevant, R.A.L.","unstructured":"Sturdevant RAL. Epidemiology of peptic ulcer. Report of a conference. Am J7 Epidemiol 1976,104:9-14.","journal-title":"Am"},{"key":"ref_11","first-page":"239","article-title":"Peptic ulcer and nonulcer dyspepsia - a disease and a disorder","volume":"6","author":"Johnsen, R.; Straume, B.; Forde, O.H.","year":"1988","unstructured":"Johnsen R, Straume B, Forde OH. Peptic ulcer and nonulcer dyspepsia - a disease and a disorder. Scand ] Prim Health Care 1988;6:239-43.","journal-title":"Scand"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/S0016-5085(85)80139-6","article-title":"Sex differences in peptic ulcer disease","volume":"88","author":"Kurata, J.H.; Haile, M.H.; Elashoff, J.D.","year":"1985","unstructured":"Kurata JH, Haile MH, Elashoff JD. Sex differences in peptic ulcer disease. Gastroenterology 1985;88:96-100.","journal-title":"Gastroenterology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1136\/gut.31.9.989","article-title":"Towards the true prevalence of peptic ulcer","volume":"31","author":"Bernersen, B.; Johnsen, R.; Straume, B.; Burhol, P.G.; Jenssen, T.G.; Stakkevold, P.A.","year":"1990","unstructured":"Bernersen B, Johnsen R, Straume B, Burhol PG, Jenssen TG, Stakkevold PA. Towards the true prevalence of peptic ulcer. Gut 1990;31:989-92.","journal-title":"Gut"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/BF01312235","article-title":"Are gastric and duodenal ulcers separate diseases or do they form a continuum?","volume":"26","author":"Kirk, R.M.","year":"1981","unstructured":"Kirk RM. Are gastric and duodenal ulcers separate diseases or do they form a continuum? Dig Dis Sci 1981;26:149-54.","journal-title":"Dig Dis Sci"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1007\/BF01312236","article-title":"Gastric and duodenal ulcer are each many different diseases","volume":"26","author":"Rotter, J.I.","year":"1981","unstructured":"Rotter JI. Gastric and duodenal ulcer are each many different diseases. Dig Dis Sci 1981;26:154-60.","journal-title":"Dig Dis Sci"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/0016-5085(88)90606-3","article-title":"Campylobacter pyloridis-associated chronic active antral gastritis","volume":"94","author":"Rauws, E.A.J.; Langenberg, W.; Houthoff, H.J.; Zanen, H.C.; Tytgat, G.N.J.","year":"1988","unstructured":"Rauws EAJ, Langenberg W, Houthoff HJ, Zanen HC, Tytgat GNJ. Campylobacter pyloridis-associated chronic active antral gastritis. Gastroenterology 1988;94:33-40.","journal-title":"Gastroenterology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1562","DOI":"10.1056\/NEJM198912073212302","article-title":"Prevalence of Helicobacter pylori infection and histologic gastritis in asymptomatic persons","volume":"321","author":"Dooley, C.P.; Cohen, H.; Fitzgibbons, P.L.","year":"1989","unstructured":"Dooley CP, Cohen H, Fitzgibbons PL, et al. Prevalence of Helicobacter pylori infection and histologic gastritis in asymptomatic persons. N Engl _J Med 1989;321:1562-6.","journal-title":"N Engl _J Med"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1136\/bmj.304.6837.1276","article-title":"Is Helicobacter pylori the cause of dyspepsia?","volume":"304","author":"Bernersen, B.; Johnsen, R.; Bostad, L.; Straume, B.; A-, Sommer; I, Burhol; P.G.","year":"1992","unstructured":"Bernersen B, Johnsen R, Bostad L, Straume B, Sommer A- I, Burhol PG. Is Helicobacter pylori the cause of dyspepsia? BMJ 1992;304:1276-9.","journal-title":"BMJ"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1007\/BF01655337","article-title":"How do clinical results after proximal gastric vagotomy compare with Visick grade pattern of healthy controls?","volume":"7","author":"Muller, C.; Engelke, B.; Fiedler, L.","year":"1983","unstructured":"Muller C, Engelke B, Fiedler L, et al. How do clinical results after proximal gastric vagotomy compare with Visick grade pattern of healthy controls? World J Surg 1983;7:610-5.","journal-title":"World J Surg"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1454","DOI":"10.1056\/NEJM198306163082405","article-title":"The Tromso heart study: does coffee raise serum cholesterol?","volume":"303","author":"Thelle, D.S.; Arnesen, E.; Forde, O.H.","year":"1983","unstructured":"Thelle DS, Arnesen E, Forde OH. The Tromso heart study: does coffee raise serum cholesterol? N Engl _J Med 1983;303: 1454-7.","journal-title":"N Engl _J Med"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1136\/jech.46.4.433","article-title":"Changing incidence of peptic ulcer - facts or artefacts? A cohort study from Tromso","volume":"46","author":"Johnsen, R.; Straume, B.; Forde, O.H.; Burhol, P.G.","year":"1992","unstructured":"Johnsen R, Straume B, Forde OH, Burhol PG. Changing incidence of peptic ulcer - facts or artefacts? A cohort study from Tromso. J Epidemiol Community Health 1992;46:433-6.","journal-title":"J Epidemiol Community Health"},{"key":"ref_22","article-title":"SUGI supplemental library user's guide. Version","author":"SAS Institutes Inc","year":"1986","unstructured":"SAS Institutes Inc. SUGI supplemental library user's guide. Version 5th ed. Cary, NC: SAS InstituteInc, 1986.","edition":"5th ed"},{"key":"ref_23","article-title":"Foundations of epidemiology","author":"Lilienfeld, A.M.; Lilienfeld, D.E.","year":"1980","unstructured":"Lilienfeld AM, Lilienfeld DE. Foundations of epidemiology. New York: Oxford University Press, 1980."},{"key":"ref_24","article-title":"Using and understanding medical statistics","author":"Matthews, D.E.; Farewll, V.T.","year":"1988","unstructured":"Matthews DE, Farewll VT. Using and understanding medical statistics. Basel: Karger AG, 1988."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"286","DOI":"10.7326\/0003-4819-84-3-286","article-title":"The effect of various forms of milk on gastric-acid secretion","volume":"84","author":"Ippoliti, A.F.; Maxwell, V.; Isenberg, J.J.","year":"1976","unstructured":"Ippoliti AF, Maxwell V, Isenberg JJ. The effect of various forms of milk on gastric-acid secretion. Ann Intern Med 1976;84:286-9.","journal-title":"Ann Intern Med"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/S0140-6736(82)91486-6","article-title":"ABH non-secretor status, blood group 0, and chronic airflow limitation","volume":"i:","author":"Kaufmann, F.","year":"1982","unstructured":"Kaufmann F. ABH non-secretor status, blood group 0, and chronic airflow limitation. Lancet 1982;i:513-4.","journal-title":"Lancet"},{"key":"ref_27","first-page":"945","article-title":"The personality pattern of patients with chronic peptic ulcer. A case-control study. Scand j Gastroenterol","volume":"18","author":"McIntosh, J.H.; Nasiry, R.W.; Frydman, M.; Waller, S.L.; Piper, D.W.","year":"1983","unstructured":"McIntosh JH, Nasiry RW, Frydman M, Waller SL, Piper DW. The personality pattern of patients with chronic peptic ulcer. A case-control study. Scand j Gastroenterol 1983;18:945-50."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"721","DOI":"10.3109\/00365528209181085","article-title":"Environmental factors and chronic gastric ulcer","volume":"17","author":"Piper, D.W.; McIntosh, J.H.; Greig, M.; Shy, C.M.","year":"1982","unstructured":"Piper DW, McIntosh JH, Greig M, Shy CM. Environmental factors and chronic gastric ulcer. Scandj Gastroenterol 1982;17:721-9.","journal-title":"Scandj Gastroenterol"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1136\/bmj.299.6691.85","article-title":"Mental distress and social conditions and lifestyle in northern Norway","volume":"299","author":"Hansen, V.; Jacobsen, B.K.","year":"1989","unstructured":"Hansen V, Jacobsen BK. Mental distress and social conditions and lifestyle in northern Norway. BMJf 1989;299:85-8.","journal-title":"BMJf"},{"key":"ref_30","first-page":"1633","article-title":"Associations between symptoms of irritable colon and psychological and social conditions and lifestyle","volume":"292","author":"Johnsen, R.; Jacobsen, B.K.; Forde, O.H.","year":"1986","unstructured":"Johnsen R, Jacobsen BK, Forde OH. Associations between symptoms of irritable colon and psychological and social conditions and lifestyle. BM3t 1986;292:1633-5."},{"key":"ref_31","first-page":"101","article-title":"The Troms0 heart study: risk factors for coronary heart disease and length of education","volume":"16","author":"Jacobsen, B.K.; Thelle, D.S.","year":"1988","unstructured":"Jacobsen BK, Thelle DS. The Troms0 heart study: risk factors for coronary heart disease and length of education. Am Epidemiol 1988;16:101-4. _","journal-title":"Am Epidemiol"}],"container-title":["Journal of Epidemiology and Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jech.48.2.156","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T14:55:29Z","timestamp":1759503329000},"score":1,"resource":{"primary":{"URL":"https:\/\/jech.bmj.com\/lookup\/doi\/10.1136\/jech.48.2.156"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1994,4]]},"references-count":31,"journal-issue":{"issue":"2","published-online":{"date-parts":[[1994,4,1]]},"published-print":{"date-parts":[[1994,4]]}},"alternative-id":["10.1136\/jech.48.2.156"],"URL":"https:\/\/doi.org\/10.1136\/jech.48.2.156","relation":{},"ISSN":["0143-005X","1470-2738"],"issn-type":[{"value":"0143-005X","type":"print"},{"value":"1470-2738","type":"electronic"}],"subject":[],"published":{"date-parts":[[1994,4]]}}}