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

Pertti Aro (1) , Jukka Ronkainen (1, 2, 3) , Tom Storskrubb (1) , Michael Vieth (4) , Lars Engstrand (5) , Sven-Erik Johansson (1) , Elisabeth Bolling-Sternevald (1, 6) , Gunilla Bolinder (7) , Kjell Alving (8) , Nicholas J. Talley (9, 10) , Lars Agréus (1)

1 Center for Family and Community Medicine, DNCSS, Karolinska Institutet
2 Institute of Health Sciences
3 Primary Health Care Center
4 Institute of pathology
5 Swedish Institute for Infectious Disease Control
6 Astra Zeneca R&D
7 Department of medicine [Stockholm]
8 Department of Women and Children's Health
9 Department of Medicine
10 Department of Medicine

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.

Mots clés: Dyspepsia; Esophagitis; Gastroesophageal reflux symptom; Peptic ulcer disease; Smoking; Snus

Pertti Aro, Jukka Ronkainen, Tom Storskrubb, Michael Vieth, Lars Engstrand, et al.. Use of tobacco products and gastrointestinal morbidity: an endoscopic population-based study (the Kalixanda study). European Journal of Epidemiology, 2010, 25 (10), pp.741-750. ⟨10.1007/s10654-010-9495-8⟩. ⟨hal-00612405⟩