Tobacco is responsible for 8 million deaths per year. This is more relevant during the COVID 19 pandemic since smokers are at risk of developing severe COVID related illness.
Tobacco affects our body adversely and harms our digestive system in a number of ways.
Smoking increases the risk of gastroesophageal reflux disease (GERD), peptic ulcer disease, damage to the pancreas and liver, Crohn’s disease and gallstones. Smoking increases the risk of various cancers of the digestive system like esophagus, stomach, pancreas and colorectal cancer.
Tobacco and gastroesophageal reflux disease
Smoking leads to a decrease in the pressure of the lower esophageal sphincter. This leads to an increase in the reflux of the gastric contents into the esophagus contributing to heartburn and GERD. The consequences of these repeated and prolonged episodes of reflux can damage the inner lining of the esophagus and increases the risk of esophageal cancer
Tobacco and Peptic Ulcer
Smoking stimulates acid secretion from the stomach and attenuates the defence mechanisms like a decrease in blood flow, mucus and bicarbonate production. Smokers also have a higher chance of developing Helicobacter Pylori infection, which by itself is a cause for peptic ulcer disease. A combination of these factors increases the risk of peptic ulcer in smokers.
Tobacco and Liver
Smoking impairs the ability of the liver to carry out important bodily functions like protein and bile formation and processing of toxic metabolites. Smoking compounds alcohol-related damage worsens conditions like primary biliary cirrhosis and non-alcoholic fatty liver disease.
Tobacco and Crohn’s disease
Smoking increases the risk of developing Crohn’s disease. This is a chronic inflammatory bowel disease that mainly affects the small intestine, however, it can involve any part of the gastrointestinal tract. This disease impairs the quality of life and can lead to potentially life-threatening complications like intestinal obstruction and fistulae. The speculated mechanisms for an increase in the risk of Crohn’s disease in smokers is still not fully understood.
Tobacco and Pancreatitis
Smoking is an independent risk factor for the development of acute pancreatitis and also exacerbates alcohol-related pancreatic damage. Pancreatitis is a potentially life-threatening inflammation of the pancreas, which can lead to autodigestion of the pancreas by activated pancreatic enzymes.
Tobacco and Gallstones
Smoking is now also been associated with an increase in the risk of developing gallstones, however, more research is needed to fully understand this relationship.
Tobacco and Gastrointestinal cancers
Smoking increases the risk of developing various gastrointestinal cancers like cancer of esophagus, stomach, pancreas, colon, rectum and anal canal.
Impact of tobacco cessation on the digestive system
The effect of quitting tobacco is variable. The effects seen stomach and liver are reversed in
a short time span. Smokers who quit are likely to have milder symptoms and a lesser chance of recurrence of Crohn’s disease. However, the risk of developing pancreatitis remains elevated even after tobacco cessation.
The theme of world no tobacco day this year is “Commit to Quit”. Everyone and anyone using tobacco in any form should pledge to quit and remove this menace from the face of the earth.
Dr. Abhishek Mitra | Senior Consultant – GI and HPB Surgery, Oncosurgery & Minimal Access Surgery | Dharamshila Narayana Superspeciality Hospital, New Delhi