Smoking Cessation Curbs Severe Reflux

Patients who quit smoking saw significant improvements in symptoms of gastroesophageal reflux (GERD), researchers found. Compared with persistent smokers who used antireflux medication on a daily basis, medication users who quit smoking saw GERD symptoms go from severe to minor or disappear completely, according to Eivind Ness-Jensen, MD, of the Norwegian University of Science and Technology in Levanger, and colleagues. However, the association was only significant among patients with a normal body mass index, not among those who were overweight, who had minor symptoms, or who used antireflux drugs on less than a weekly basis, according to the American Journal of Gastroenterology. More than a decade of research has shown associations between gastroesophageal reflux symptoms and disease with smoking, although no prior research has looked at whether smoking cessation would resolve those symptoms over the long-term. The authors looked at the issue using data from the Nord-Trøndelag health (HUNT) study, which invites all residents age 20 or older in Norway’s Nord-Trøndelag county to participate in a survey. For the current study, the researchers used responses from the 1995-1997 and 2006-2008 surveys. Participants were asked a series of health questions, including whether they suffered from heartburn or acid regurgitation over the preceding 12 months. They also had follow-up clinical and laboratory examinations.

Responses between the time periods were compared. Additionally, respondents were asked about smoking habits between the two-time periods. The authors defined those who quit smoking or reduced daily smoking to occasional smoking as being “exposed” to smoking cessation. Confounders included sex, age, alcohol consumption, education, physical exercise, BMI, and use of antireflux medication. Prescriptions are required for proton pump inhibitors and histamine-2-receptor antagonists, while antacids and low-dose histamine-2-receptor antagonists are available over-the-counter. Information on use of medications was based on data recorded through the Norwegian Prescription Database, as well as a question on frequency of use for over-the-counter antireflux medications.

Of the respondents who reported reflux symptoms, 29,610 reported them at both the 1995-1997 and 2006-2008 measures. Some 5% had severe symptoms, and of that portion 31% (n=486) were daily smokers. Nearly 200 of those (n=182) had quit smoking and 31 reduced smoking between the two surveys. Roughly two-thirds (60%) used antireflux medication at least weekly. Mean BMI was similar between groups and obesity was less common among those who were persistent daily smokers. There was no association between smoking cessation and gastroesophageal symptoms among those using no antireflux medication or who used it on less than a weekly basis.

“The results of our study suggest that tobacco smoking cessation may improve severe gastroesophageal reflux symptoms among normal weight individuals in the general population,” they wrote, cautioning that the association did not imply a causal relationship, or that there was no measure of whether symptoms resolved before or after smoking cessation. They also noted that the lack of improvement in patients with overweight or obesity “might be explained by the strong association between BMI and gastroesophageal symptoms, which might dominate compared with the effect of tobacco smoking.”

Medpage Today

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