title: Use of tobacco products and gastrointestinal morbidity: an endoscopic population-based study (the Kalixanda study).
abstract: 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 Helicobacter pylori infection. A random sample (n = 2,860) of the adult population of two northern Swedish municipalities Kalix and Haparanda (n = 21,610) was surveyed between December 1998 and June 2001 using a validated postal questionnaire assessing gastrointestinal symptoms (response rate 74.2%, n = 2,122) (The Kalixanda Study). A random sub-sample (n = 1,001) of the responders was invited to undergo an esophagogastroduodenoscopy (participation rate 73.3%) including biopsies, Helicobacter pylori 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 Helicobacter pylori 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.
authors.affiliation: Center for Family and Community Medicine, DNCSS, Karolinska Institutet, Stockholm, Sweden. pertti.aro@fimnet.fi
authors.forename: Pertti
authors.initials: P
authors.lastname: Aro
authors.forename: Jukka
authors.initials: J
authors.lastname: Ronkainen
authors.forename: Tom
authors.initials: T
authors.lastname: Storskrubb
authors.forename: Michael
authors.initials: M
authors.lastname: Vieth
authors.forename: Lars
authors.initials: L
authors.lastname: Engstrand
authors.forename: Sven-Erik
authors.initials: SE
authors.lastname: Johansson
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Bolling-Sternevald
authors.forename: Gunilla
authors.initials: G
authors.lastname: Bolinder
authors.forename: Kjell
authors.initials: K
authors.lastname: Alving
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Talley
authors.forename: Lars
authors.initials: L
authors.lastname: Agréus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery; D016481:Helicobacter Infections / Q000209:etiology; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D014030:Tobacco, Smokeless / Q000009:adverse effects*; D055815:Young Adult