Recent findings suggest that e-cigarette use—both current and former—is independently associated with a risk of peptic ulcer disease, according to an oral abstract presented at the American College of Gastroenterology Scientific Meeting in Phoenix, Arizona, October

Presenting author Albert E. Orhin, MBChB, MHS, from Ascension Saint Agnes Hospital in Baltimore, Maryland, noted that peptic ulcer disease (PUD) continues to represent a substantial source of gastrointestinal morbidity. While cigarette smoking has long been implicated as a risk factor, the growing prevalence of electronic cigarette (e-cigarette) use raises new concerns regarding potential gastrointestinal effects.

This cross-sectional study used data from 371,398 adults enrolled in the National Institutes of Health All of Us Research Program to examine associations between e-cigarette use and peptic ulcer disease.

E-cigarette use was determined through self-reported survey data and categorized as never, former, or current use. The primary outcome, PUD, was defined using validated electronic health record codes. Multivariable logistic regression models estimated adjusted odds ratios (aORs) and 95% CIs, accounting for demographic and behavioral covariates including traditional cigarette use, NSAID use, alcohol consumption, and gastroesophageal reflux disease (GERD).

Among participants, 29,373 (8%) reported ever using e-cigarettes. Users were younger (mean age, 45.3 vs 59.3 years; P < .001), more frequently female, and more likely to report lower education and income levels (P < .001). Ever use of e-cigarettes was associated with significantly increased odds of PUD (aOR, 1.17; 95% CI, 1.09–1.26). Stratified analyses showed elevated odds for both current (aOR, 1.27; 95% CI, 1.12–1.45) and former users (aOR, 1.13; 95% CI, 1.04–1.24). Additional independent predictors included 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), whereas female sex was associated with lower odds (aOR, 0.88; 95% CI, 0.85–0.92).

The researchers concluded that e-cigarette use—both current and former—is independently associated with PUD risk. Given increasing e-cigarette popularity, particularly among younger adults, clinicians should consider e-cigarette exposure in gastrointestinal risk assessments. Prospective studies are needed to clarify causality and underlying mechanisms.

Reference: Orhin AE, Akoto NAY, Mensah B, et al. Oral abstract 6 - Association between e-cigarette use and peptic ulcer disease: a cross-sectional study from the All of Us research program. Presented at ACG Scientific Meeting. October 27, 2025. Phoenix, AZ