S1321 Association Between E-Cigarette Use and Peptic Ulcer Disease: A Cross-Sectional Study From the All of Us Research Program

Introduction: Peptic ulcer disease (PUD) remains a prevalent gastrointestinal condition associated with significant morbidity. While cigarette smoking is an established risk factor, the potential impact of e-cigarette use, especially amid its rising popularity among younger adults, on PUD risk has not been well characterized. This study examined the association between e-cigarette use and PUD using a large, nationally representative cohort. Methods: We conducted a cross-sectional analysis of adults enrolled in the NIH All of Us Research Program. E-cigarette use was categorized from self-reported survey responses as ever versus never use and further stratified as never, former, or current use. The primary outcome was PUD, defined using validated electronic health record diagnosis codes. Multivariable logistic regression models estimated adjusted odds ratios (aORs) and 95% CIs for PUD, adjusting for age, gender, race and ethnicity, traditional cigarette use, nonsteroidal anti-inflammatory drug use (NSAID), alcohol use, and GERD. Results: Among 371,398 participants, 29,373 (8%) reported ever using e-cigarettes, including 21,277 current users and 8,096 former users. E-cigarette users were significantly younger (mean age 45.3 versus 59.3 years; P < 0.001), more likely to be woman, and more likely to report lower educational attainment and income levels (P < 0.001). Ever e-cigarette use was associated with higher odds of PUD (aOR: 1.17; 95% CI: 1.09-1.26) compared to never use. When stratified, current users had 27% higher odds (aOR: 1.27; 95% CI: 1.12-1.45), and former users had 13% higher odds (aOR: 1.13; 95% CI: 1.04-1.24) compared to never users. NSAID use (aOR: 2.15; 95% CI: 2.06-2.23), GERD (aOR: 4.45; 95% CI: 4.28-4.62), and traditional cigarette use (aOR: 1.19; 95% CI: 1.15-1.24) were also significant predictors of PUD risk, while female sex was associated with lower odds (aOR: 0.88; 95% CI: 0.85-0.92). Conclusion: E-cigarette use, including both former and current use, is associated with significantly increased odds of peptic ulcer disease, independent of traditional risk factors such as cigarette smoking, NSAID use, and gastroesophageal reflux disease. These findings raise important concerns regarding the gastrointestinal safety of electronic nicotine delivery systems. Further prospective studies are warranted to investigate causality and determine whether e-cigarette use should be considered in gastrointestinal risk assessments, particularly among younger adults.