PHOENIX — A cross-sectional analysis presented at the American College of Gastroenterology (ACG) 2025 meeting found that adults who use e-cigarettes had higher odds of peptic ulcer disease (PUD) than people who never vaped — and former e-cigarette users also showed increased risk.

Albert E. Ohrin, MBChB, MHS, a first-year internal medicine resident at Ascension Saint Agnes Hospital in Baltimore, reported the findings. He said he was prompted to investigate after seeing Reddit posts from e-cigarette users reporting worsening PUD and because vaping remains common among young people.

Study setup and prevalence
Ohrin and colleagues analyzed data from 371,398 adults enrolled in the NIH All of Us Research Program. E-cigarette use was self-reported; PUD was identified using validated electronic health record diagnosis codes. Of the participants, 29,373 (8%) reported e-cigarette use — 21,277 current users and 8,096 former users. E-cigarette users were significantly younger (mean age 45.3 vs 59.3 years; P < .001), more likely to be female, and more likely to report lower education and income (P < .001). Background context: vaping remains common. The National Youth Tobacco Survey reported 1.6 million US middle and high school students (5.9%) vaped in 2024 (down from 7.7% in 2023). Among adults, CDC data show e-cigarette use rose to 6.5% in 2023 from 3.7% in 2020. Key findings - Current e-cigarette users had 27% higher odds of PUD compared with never-users (adjusted odds ratio [aOR], 1.27; 95% CI, 1.12–1.45). This was slightly higher than the association seen with traditional combustible cigarettes in the study (aOR, 1.19). - Former e-cigarette users had 13% higher odds of PUD (aOR, 1.13; 95% CI, 1.04–1.24) compared with never-users. - Any e-cigarette use was associated with increased odds of PUD (aOR, 1.17; 95% CI, 1.09–1.26). For context, use of nonsteroidal anti-inflammatory drugs (aOR, 2.15) and a diagnosis of gastroesophageal reflux disease (aOR, 4.45) were the strongest risk factors for PUD in the analysis. Limitations and next steps Ohrin noted surprise that former users still showed higher odds of PUD, but emphasized the study could not assess frequency of vaping or how long participants had quit. “Now that we know there’s an association, we are going to do more studies on e-cigarettes” to better define potential gastrointestinal harms, he told Medscape. He added that determining whether a dose–response relationship exists would require prospective trials. Expert perspective Laura Crotty Alexander, MD, a pulmonology and critical care researcher at UC San Diego who has studied e-cigarette health effects for a decade, called the finding novel and important. She noted prior work showing nicotine can increase gastric acid production and impair healing, and that with combustible cigarettes other toxic smoke constituents also contribute to PUD risk. Her own in vitro and mouse studies indicate e-cigarette aerosols can be irritants and cause oxidative stress — mechanisms that could plausibly affect the gastrointestinal tract. Crotty Alexander said the study “opens a door” to examining vaping’s effects on the GI system and reminded clinicians to include vaping when taking inhalant histories. Disclosures Ohrin and Crotty Alexander reported no conflicts. Reporting by Alicia Ault, freelance journalist, Saint Petersburg, Florida. She can be found on X @aliciaault and on Bluesky @aliciaault.bsky.social.