The Inhibitory Effect of Smoking on the Lower Esophageal Sphincter.

Dennish, George W.

doi:10.7326/0003-4819-74-5-834_1

Cited by 41 publications

(48 citation statements)

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“…37 As a consequence of these results it could be argued that omeprazole 10 mg daily should be suggested as the appropriate initial maintenance dose in patients over 65 years of age. Smoking has long been considered to be a factor in the pathogenesis of re¯ux oesophagitis, 38,39 though there is relatively little good evidence that supports this view. It has been found that smoking has an adverse impact on healing of oesophagitis with ranitidine.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors influencing relapse of oesophagitis during maintenance therapy with antisecretory drugs: a meta‐analysis of long‐term omeprazole trials

Carlsson

Galmiche

Lundell

et al. 1997

Aliment Pharmacol Ther

133

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Background: This meta‐analysis investigated factors that may affect the risk of relapse of oesophagitis, and evaluated the predictive value of symptoms for the presence of relapse during long‐term treatment. Methods: Individual data from 1154 patients included in five independently conducted, randomized, long‐term clinical trials of the efficacy of different dosage regimens of omeprazole, standard ranitidine treatment and placebo for the prevention of relapse of oesophagitis were pooled for this meta‐analysis. The therapeutic regimens studied were omeprazole 20 mg o.m. (OME20) in 366 patients, omeprazole 10 mg o.m. (OME10) in 225 patients, omeprazole 20 mg weekends (OMEW) in 235 patients, ranitidine 150 mg b.d. (RAN) in 179 patients, or placebo (PLA) in 149 patients. Results: OME20 maintained 82.4% (95% CI: 78.2–86.6%) of patients in endoscopic remission over the 6‐month period compared to 71.9% (95% CI: 65.5–78.3%) for OME10, 52.3% (95% CI: 44.4–60.1%) for RAN, 42.7% (95% CI: 35.8–49.5%) for OMEW, and 10.6% (95% CI: 5.0–16.3%) for PLA. A Cox's regression analysis of time to recurrence of oesophagitis showed that four factors were associated with a higher relapse rate during placebo and active maintenance therapy: (a) pre‐treatment severity of oesophagitis (P<0.0001), (b) young age (P=0.01), (c) non‐smoking (P=0.02) and (d) moderate/severe regurgitation before entry into the trials (P=0.03). Asymptomatic relapse of oesophagitis was uncommon, being found in only 8.6% of the patients. Conclusions: Maintenance treatment with omeprazole 10 and 20 mg daily is superior to all other regimens tested, and is only marginally influenced by the pre‐treatment severity of oesophagitis. Age contributes to the factors that influence the outcome during long‐term treatment with omeprazole. Symptom relief is highly predictive for the maintenance of healing.

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Section: Discussionmentioning

confidence: 99%

Prognostic factors influencing relapse of oesophagitis during maintenance therapy with antisecretory drugs: a meta‐analysis of long‐term omeprazole trials

Carlsson

Galmiche

Lundell

et al. 1997

Aliment Pharmacol Ther

133

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“…The present research focused on the relative importance of visceral sensitivity, manifested by positive Rome I criteria for IBS, in relation to extrinsic factors, namely, acid exposure and smoking, in GERD symptoms. Smoking may promote GER by several mechanisms, including attenuation of the tone at the lower oesophageal sphincter, [18][19][20] a decrease in salivary flow and bicarbonate secretion with a resultant prolongation of acid clearance, [20][21][22] and a delay in gastric emptying. 30,31 Some additional effects of smoking and nicotine that may be relevant to GERD are an increase in gastric acid and pepsin secretion, augmentation of duodeno-gastric bile reflux and attenuation of the protective mechanisms of the gastric mucosa, such as synthesis of prostaglandins, mucus and epidermal growth factor.…”

Section: Discussionmentioning

confidence: 99%

“…osmolality and fat content, [15][16][17] smoking, [18][19][20][21][22] emotional factors 23 and visceral hypersensitivity. 15,16 This latter feature is considered a biological marker of the irritable bowel syndrome (IBS), 24 a condition associated with GERD.…”

Section: Introductionmentioning

confidence: 99%

Irritable bowel, smoking and oesophageal acid exposure: an insight into the nature of symptoms of gastro‐oesophageal reflux

Zimmerman¹

2004

Aliment Pharmacol Ther

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Summary Background : In gastro‐oesophageal reflux disease, oesophageal acid exposure correlates with symptoms but explains only a small fraction of their variance. Aims : To elucidate the effects of irritable bowel syndrome and smoking on gastro‐oesophageal reflux disease symptoms and to clarify whether they modulate the relationship between oesophageal acid exposure and symptoms. Methods : The relationship between oesophageal acid exposure, irritable bowel syndrome (Rome I criteria), smoking status and symptoms was investigated in patients with a normal gastroscopy who underwent a 24‐h oesophageal pH monitoring. Results : Of 256 patients with gastro‐oesophageal reflux disease, 16% were smokers and 50% met the criteria for irritable bowel syndrome (irritable bowel syndrome+). The extent of oesophageal acid exposure was unrelated to smoking or irritable bowel syndrome status. Oesophageal acid exposure, irritable bowel syndrome status and current smoking independently predicted symptoms. Irritable bowel syndrome and smoking modulated the effect of oesophageal acid exposure on symptoms: oesophageal acid exposure was predictive of symptoms only in non‐smokers. However, irritable bowel syndrome was a significant predictor of symptoms both in smokers and in non‐smokers. Smoking was associated with symptoms only in irritable bowel syndrome+, while oesophageal acid exposure was associated with symptoms irrespective of irritable bowel syndrome status. Conclusions : In patients with non‐erosive gastro‐oesophageal reflux disease, smoking and irritable bowel syndrome independently predicted symptoms, without affecting the extent of oesophageal acid exposure. The relationship between oesophageal acid exposure and symptoms was affected significantly, and in opposite directions, by smoking and irritable bowel syndrome.

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“…11, 12 Tobacco smoking can reduce the pressure of the lower esophageal sphincter (LES), 13 and decrease salivary bicarbonate secretion, thus reducing the physiological neutralizing effect of the saliva on intraesophageal acid. 14 Thus, smoking may be a risk factor for GERD as indicated by some, 15-18 but not all, 19, 20 epidemiological studies.…”

Section: Introductionmentioning

confidence: 99%

Lifestyle Factors and Risk for Symptomatic Gastroesophageal Reflux in Monozygotic Twins

et al. 2007

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The Inhibitory Effect of Smoking on the Lower Esophageal Sphincter.

Cited by 41 publications

References 0 publications

Prognostic factors influencing relapse of oesophagitis during maintenance therapy with antisecretory drugs: a meta‐analysis of long‐term omeprazole trials

Prognostic factors influencing relapse of oesophagitis during maintenance therapy with antisecretory drugs: a meta‐analysis of long‐term omeprazole trials

Irritable bowel, smoking and oesophageal acid exposure: an insight into the nature of symptoms of gastro‐oesophageal reflux

Lifestyle Factors and Risk for Symptomatic Gastroesophageal Reflux in Monozygotic Twins

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