Role of smoking in functional dyspepsia and irritable bowel syndrome: three random population-based studies

Nicholas J. Talley*, Nicholas Powell, Marjorie M. Walker, Mike P. Jones, Jukka Ronkainen, Anna Forsberg, Lars Kjellström, Per M. Hellström, Pertti Aro, Bengt Wallner, Lars Agréus, Anna Andreasson

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    4 Citations (Scopus)

    Abstract

    Background

    It is uncertain if functional dyspepsia (FD) or irritable bowel syndrome (IBS) are linked to smoking, and smoking cessation is not part of the routine advice provided to these patients. 

    Aim

    To assess if smoking is an independent risk factor for FD and IBS. 

    Methods

    Three population-based endoscopy studies in Sweden with 2560 community individuals in total (mean age 51.5 years, 46% male). IBS (14.9%), FD (33.5%), and associated symptoms were assessed using the validated abdominal symptom questionnaire, and smoking (17.9%) was obtained from standardised questions during a clinic visit. The effect of smoking on symptom status was analysed in an individual person data meta-analysis using mixed effect logistic regression, adjusted for snuffing, age and sex. 

    Results

    Individuals smoking cigarettes reported significantly higher odds of postprandial distress syndrome (FD-PDS) (OR 10-19 cig/day = 1.42, 95% CI 1.04-1.98 P = 0.027, OR ≥20 cig/day = 2.16, 95% CI 1.38-3.38, P = 0.001) but not epigastric pain. Individuals smoking 20 or more cigarettes per day reported significantly higher odds of IBS-diarrhoea (OR = 2.40, 95% CI 1.12-5.16, P = 0.025), diarrhoea (OR = 2.01, 95%CI 1.28-3.16, P = 0.003), urgency (OR = 2.21, 95%CI 1.41-3.47, P = 0.001) and flatus (OR = 1.77, 95%CI 1.14-2.76, P = 0.012) than non-smokers. Smoking was not associated with IBS-constipation or IBS-mixed. 

    Conclusion

    Smoking is an important environmental risk factor for postprandial distress syndrome, the most common FD subgroup, with over a twofold increased odds of PDS in heavy smokers. The role of smoking in IBS-diarrhoea, but not constipation, is also likely important.

    Original languageEnglish
    Pages (from-to)32-42
    Number of pages11
    JournalAlimentary Pharmacology and Therapeutics
    Volume54
    Issue number1
    Early online date13 May 2021
    DOIs
    Publication statusPublished - Jul 2021

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