Tobacco Smoking Cessation and Improved GERD
Tobacco Smoking Cessation and Improved GERD
We have previously published a complete flowchart of the participants. In HUNT 2 and HUNT 3/Mini-Q, 58,869 individuals (64% response rate) and 44,997 individuals (49%) reported GERS status, respectively. Among these, the 29,610 individuals (61%) who reported GERS status at both time points were eligible. The average follow-up time was approximately 11 years. Among the 1553 participants with severe GERS (5%) in HUNT 2, the 486 (31%) who were daily tobacco smokers were included in the present study. Of these participants, 182 quitted smoking and 31 reduced to occasional smoking. In total, 213 (44%) were previous daily smokers, whereas 251 (52%) were persistent daily smokers in HUNT 3/Mini-Q. In both these groups, about 60% were using antireflux medication at least weekly (Figure 1). The mean BMI was similar between the groups, but obesity was less common among the persistent daily smokers. Compared with the previous daily smokers, the persistent daily smokers were characterized by higher female representation, lower mean age, lower education, lower level of physical exercise, and lower alcohol consumption (Table 1).
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Figure 1.
Flow chart of study participants. GERS, gastroesophageal reflux symptoms; HUNT, Nord-Trøndelag health study.
Among the daily tobacco smokers with severe GERS in HUNT 2 using no or less than weekly antireflux medication, there was no statistically significant association between tobacco smoking cessation and GERS status (adjusted OR 0.95; 95% CI: 0.39–2.30) compared with persistent daily smoking (Table 2). However, among the daily tobacco smokers with severe GERS in HUNT 2 using at least weekly antireflux medication, tobacco smoking cessation was associated with an improvement in GERS status from severe to no or minor complaints (adjusted OR 1.78; 95% CI: 1.07–2.97) compared with persistent daily smoking (Table 2). Secondary, subgroup analyses found that the association only was present among individuals within the normal weight range (adjusted OR 5.67; 95% CI: 1.36–23.64), but not among overweight individuals (Table 3 and Figure 2). There was no association between tobacco smoking cessation and GERS status among individuals with minor GERS in HUNT 2 (data not shown).
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Figure 2.
Odds ratio and 95% confidence interval (CI) of improvement in severe gastroesophageal reflux symptoms by tobacco smoking cessation, comparing previous daily tobacco smokers with persistent daily tobacco smokers as reference. Restricted to those using at least weekly antireflux medication and stratified by body mass index (BMI). Model adjusted for sex, age, alcohol consumption, education, and physical exercise.
Results
Participants
We have previously published a complete flowchart of the participants. In HUNT 2 and HUNT 3/Mini-Q, 58,869 individuals (64% response rate) and 44,997 individuals (49%) reported GERS status, respectively. Among these, the 29,610 individuals (61%) who reported GERS status at both time points were eligible. The average follow-up time was approximately 11 years. Among the 1553 participants with severe GERS (5%) in HUNT 2, the 486 (31%) who were daily tobacco smokers were included in the present study. Of these participants, 182 quitted smoking and 31 reduced to occasional smoking. In total, 213 (44%) were previous daily smokers, whereas 251 (52%) were persistent daily smokers in HUNT 3/Mini-Q. In both these groups, about 60% were using antireflux medication at least weekly (Figure 1). The mean BMI was similar between the groups, but obesity was less common among the persistent daily smokers. Compared with the previous daily smokers, the persistent daily smokers were characterized by higher female representation, lower mean age, lower education, lower level of physical exercise, and lower alcohol consumption (Table 1).
(Enlarge Image)
Figure 1.
Flow chart of study participants. GERS, gastroesophageal reflux symptoms; HUNT, Nord-Trøndelag health study.
Associations
Among the daily tobacco smokers with severe GERS in HUNT 2 using no or less than weekly antireflux medication, there was no statistically significant association between tobacco smoking cessation and GERS status (adjusted OR 0.95; 95% CI: 0.39–2.30) compared with persistent daily smoking (Table 2). However, among the daily tobacco smokers with severe GERS in HUNT 2 using at least weekly antireflux medication, tobacco smoking cessation was associated with an improvement in GERS status from severe to no or minor complaints (adjusted OR 1.78; 95% CI: 1.07–2.97) compared with persistent daily smoking (Table 2). Secondary, subgroup analyses found that the association only was present among individuals within the normal weight range (adjusted OR 5.67; 95% CI: 1.36–23.64), but not among overweight individuals (Table 3 and Figure 2). There was no association between tobacco smoking cessation and GERS status among individuals with minor GERS in HUNT 2 (data not shown).
(Enlarge Image)
Figure 2.
Odds ratio and 95% confidence interval (CI) of improvement in severe gastroesophageal reflux symptoms by tobacco smoking cessation, comparing previous daily tobacco smokers with persistent daily tobacco smokers as reference. Restricted to those using at least weekly antireflux medication and stratified by body mass index (BMI). Model adjusted for sex, age, alcohol consumption, education, and physical exercise.
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