Use of tobacco products and gastrointestinal morbidity: an endoscopic population-based study (the Kalixanda study)

• Published in: European Journal of Epidemiology
• Main Authors: Aro, Pertti, Ronkainen, Jukka, Storskrubb, Tom, Vieth, Michael, Engstrand, Lars, Johansson, Sven-Erik, Bolling-Sternevald, Elisabeth, Bolinder, Gunilla, Alving, Kjell, Talley, Nicholas J., Agréus, Lars
• Other Authors: Center for Family and Community Medicine, DNCSS, Karolinska Institutet, Institute of Health Sciences, University of Oulu, Primary Health Care Center, Institute of pathology, Institute of Pathology, Swedish Institute for Infectious Disease Control, Astra Zeneca R&D, Department of medicine Stockholm, Karolinska Institutet Stockholm -Karolinska University Hospital Stockholm, Department of Women and Children's Health, Uppsala University, Department of Medicine, Mayo Clinic, University of Sydney and Nepean Hospital
• Format: Article in Journal/Newspaper
• Language: English
• Published: HAL CCSD 2010
• Subjects: Dyspepsia; Esophagitis; Gastroesophageal reflux symptom; Peptic ulcer disease; Smoking; Snus; Haparanda; Kalix
• Online Access: https://hal.archives-ouvertes.fr/hal-00612405; https://hal.archives-ouvertes.fr/hal-00612405/document; https://hal.archives-ouvertes.fr/hal-00612405/file/PEER_stage2_10.1007%252Fs10654-010-9495-8.pdf; https://doi.org/10.1007/s10654-010-9495-8

International audience The impact of snus (smokeless tobacco or snuff) on gastrointestinal symptoms and pathological findings is largely unknown. The authors aimed to investigate whether the exposure to different forms of tobacco influences upper gastrointestinal symptoms, histology and frequency of infection. A random sample ( = 2,860) of the adult population of two northern Swedish municipalities Kalix and Haparanda ( = 21,610) was surveyed between December 1998 and June 2001 using a validated postal questionnaire assessing gastrointestinal symptoms (response rate 74.2%, = 2,122) (The Kalixanda Study). A random sub-sample ( = 1,001) of the responders was invited to undergo an esophagogastroduodenoscopy (participation rate 73.3%) including biopsies, culture and serology and symptom assessment and exploration of present and past use of tobacco products. No symptom groups were associated with snus use. Snus users had a significantly higher prevalence of macroscopic esophagitis univariately but snus use was not associated with esophagitis in multivariate analysis. Snus use was associated with basal cell hyperplasia (OR = 1.74, 95% CI: 1.02, 3.00) and with elongation of papillae (OR = 1.79, 95% CI: 1.05-3.05) of the squamous epithelium at the esophago-gastric junction. Current smoking cigarettes was associated with overall peptic ulcer disease (OR = 2.32, 95% CI: 1.04, 5.19) whereas snus use was not. There were no significant association between current infection and different tobacco product user groups. Snus significantly alters the histology of the distal esophagus but does not impact on gastrointestinal symptoms or peptic ulcer disease.