Background: Peptic ulcer disease is a common clinical problem. Binge drinking has been shown to increase the risk of peptic ulcer at the individual level.
Purpose: To estimate the aggregate level beverage-specific effect of alcohol on peptic ulcer disease mortality rate.
Method: Trends in peptic ulcer disease mortality rate and beverage-specific level of alcohol sale from 1970 to 2005 in Belarus were analyzed applying the ARIMA time series analysis.
Results: The results of analysis suggest close relationships between peptic ulcer mortality rate and level of strong spirits (vodka) sale per capita.
Conclusion: This paper presents new epidemiological evidence of aggregate level relation between the peptic ulcer mortality rate and strong spirits sale per capita. The outcome of this study also supports the hypothesis that binge drinking of strong spirits is a risk factor for peptic ulcer at the population level. (Alcoholism 2006; 42:61-68)
Key words: Peptic ulcer disease; Alcohol sale; ARIMA time series analysis; Belarus, 1970-2005.
Peptic ulcer disease (PUD) is one of the common disorders affecting the digestive system. The lifetime risk for peptic ulcer is 5-10% in developed countries.1 The pathology of peptic ulcer is complex and may involve the overproduction of acid or pepsin, inadequate mucosal defense, reflux of bile and pancreatic juice into stomach.2 Peptic ulcer is a classical example of the biopsychosocial model of disease. Although Helicobacter pylori is considered causal for peptic ulcer, a variety of host factors besides infection may play an important contributing role for this disease: smoking, alcohol consumption, non-steroid anti-inflammatory drug use and psychosocial stress.3
Studies on the relationship between alcohol consumption and risk for PUD, that have been published during the last decade have reported the conflicting results. There is a large body of clinical and research evidence that the excessive alcohol consumption increases the risk of PUD by impairing the mucosal defense mechanisms.4'5 In one longitudinal prospective study, it was shown that, when compared with those who consumed less than 1.5 units of alcohol per week, the individuals who consumed 63 units of alcohol per week are 4 times more likely to develop a bleeding ulcer.6 On the other hand, several large-scale prospective studies have suggested a protective effect of moderate alcohol consumption (one or two drink a day) on the development of gastric ulcer.3·7 In the prospective cohort study, a tendency towards an increase in the PUD incidence proportion with the number of consumed drinks was observed resulting in a U-shaped relationship.8
Several researchers had reported a protective effect of wine and beer consumption against the active Helicobacter pylori infection.9,7 There are several possible biological mechanisms that could explain the protective effects of moderate alcohol consumption: 1) moderate alcohol intake might invigorate the mucosal defense by its effects on prostaglandins; 2) the increased gastrin secretion and the resulting rise in gastric acid production enhance the antibacterial activity; 3) wine has a strong antibacterial effect.9·10 There is also evidence of a beverage-specific effect of alcohol on PUD risk: wine drinking showed a protective effect against ulceration, whereas intake of spirits increased ulcer risk.8 A study that addressed the role of drinking pattern in relation to risk of PUD suggests that the binge drinking substantially increases the risk. For example, the Danish study provides evidence that wine drinking is associated with a much lower risk than beer drinking.6 This might reflect the fact that the beer drinkers are more likely to take alcohol in binge session than wine drinkers. Thus, the research evidence suggests that alcohol consumption may be related to positive or negative risk factors of PUD, depending on dose and type of drinking. …