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PUD (see also Chapter 53)
Large epidemiologic studies have demonstrated a consistently increased risk of gastric cancer in patients with a history of a gastric ulcer. In a cohort study Swedish adults who were followed for an average of 9 years, a history of gastric ulcer was associated with a 1.8-fold increased risk of gastric cancer.231 Interestingly, a history of duodenal ulcer was associated with a reduced risk of gastric cancer. These findings were replicated in a case control study of U.S. veterans.232The associations were confined to non-cardia gastric cancer; there was no association between history of gastric ulcer and cardia cancer.232 It is unclear whether gastric ulcers per se predispose to the development of cancer. The increase risk may be mediated by infection with Hp, which can lead to atrophic gastritis, intestinal metaplasia, and cancer.