Effects of alcohol consumption, cigarette smoking, and betel quid chewing on upper digestive diseases: a large cross-sectional study and meta-analysis

Abstract

Cigarette smoking is a well-known risk factor of upper digestive diseases. Findings on alcohol's effect on these diseases are inconsistent and with the exception of its association with esophageal cancer, little is known about betel quid chewing. This study investigated the association between use of these three substances and upper digestive diseases. We collected data from 9,275 patients receiving upper endoscopies between April 2008 and December 2013. Polynomial regressions were used to analyze the association between risk factors and diseases of the esophagus, stomach and duodenum. Meta-analysis for use of these substances and esophageal diseases was also performed. Participants who simultaneously consumed cigarettes, alcohol and betel quid had a 17.28-fold risk of esophageal cancer (95% CI = 7.59–39.33), 2.99-fold risk of Barrette's esophagus (95% CI = 2.40–4.39), 1.60-fold risk of grade A-B erosive esophagitis (95% CI = 1.29–2.00), 2.00-fold risk of gastric ulcer (95% CI = 1.52–2.63), 2.12-fold risk of duodenitis (95% CI = 1.55–2.89) and 1.29-fold risk of duodenal ulcer (95% CI = 1.01–1.65). Concurrent consumption of more substances was associated with significantly higher risk of developing these diseases. Meta-analysis also revealed use of the three substances came with a high risk of esophageal diseases. In conclusions, cigarette smoking, alcohol drinking and betel quid chewing were associated with upper digestive tract diseases.

Risks of substance uses, alcohol flush response, Helicobacter pylori infection and upper digestive tract diseases—An endoscopy cross‐sectional study

“…The risk intensity of substances used may be slightly fluctuated, depending on different indicators such as age at start, daily average, and cumulative amount were applied. Previous population and laboratory studies have found that cumulative consumption of alcohol, cigarette, or areca nut, the common substances used in Asia countries, have largely contributed to the development of different upper digestive diseases . The similar findings of this study suggested the validity of this study design.…”

“…Second, substance dosage were collected by questionnaire, so there may be some recall bias, though questionnaire was designed and interviewer was trained to reduce this bias. In addition, our previous studies have validated the good quality of information about those three substances used . Third, we had fewer ESCC patients; thus, the results of further analysis such as dose‐response of substance exposure and ESCC risk might fluctuate and were less reliable than our previous case‐control studies .…”

“…Our previous study has demonstrated a good validity of questionnaire‐collected data on history of substance use (alcohol, cigarette, and areca nut), by comparing that data with measurements of safrole‐DNA adducts, urinary cotinine and creatinine and serum acetaldehyde, all known markers of substance use . A test‐retest reliability assessment of the questionnaire comparing baseline substance use answers with retest answers 1 month later (n = 409) also found the results of Kappa coefficient more than 0.7 and Spearman's correlation more than 0.8 revealed acceptable reliability …”

“…This study design has been described in detail in our earlier study . In short, we recruited 9275 subjects who aged ≥20 years, received upper endoscopies, agreed to participate, and did not have diagnosed and treated for gastric‐esophagus cancers or upper digestive tract operations in outpatient clinics at four hospitals (Kaohsiung Medical University Hospital [KMUH], Kaohsiung Municipal Hsiao‐Kang Hospital [KMHK], Ping‐Tung Hospital [PTH], and Heng‐Chun Tourism Hospital [HCTH]), located on southwestern coast of Taiwan, between April 2008 and December 2013 (Figure S1).…”

“…These three substances were highly associated with certain diseases in upper digestive tract . Our recent meta‐analysis study examined the association of whether habitual use of these three substances with risk of esophageal diseases and found that alcohol drinkers, cigarette smokers, and areca nut chewers had significantly higher risks of any esophageal diseases, particularly esophageal squamous cell carcinoma (ESCC), with adjusted odds ratios (aORs) of 4.17 (95% confidence interval [CI]: 2.71‐6.41), 3.03 (95% CI: 1.91‐4.81), and 3.33 (95% CI: 1.84‐6.03), respectively. In addition, our large‐scale endoscopy cohort with 9275 adult patients receiving upper endoscopies found that patients who regularly used these three substances simultaneously had a 17.28‐fold risk of esophageal cancer, 2.99‐fold risk of Barrett's esophagus, 2.00‐fold risk of gastric ulcer, and 1.29‐fold risk of duodenal ulcer .…”