Does smoking have harmful effects on the digestive system? Answers from Dr. Badran

Smoking has been shown to have harmful effects on all parts of the digestive system, contributing to common complaints such as heartburn and peptic ulcers. It also increases the risk of Crohn’s disease and possibly gallstones. Smoking also appears to affect the liver by changing the way it handles drugs and alcohol. Smoking can also make pancreatitis worse.

In addition, smoking is a risk factor for cancer of the mouth, lips and larynx, as well as cancer of the esophagus, stomach, pancreas, liver, colon and rectum.

In fact, there seems to be enough evidence to quit smoking on the basis of digestive upset alone.

Smoking and Heartburn

Heartburn occurs when acidic stomach juices splash up into the esophagus. Normally, a muscular valve at the lower end of the esophagus, the lower esophageal sphincter, keeps acidic solution in the stomach and out of the esophagus. Smoking decreases the strength of the esophageal valve, allowing gastric juice to flow back or back up into the esophagus.

Smoking also appears to promote the movement of bile salts from the intestine to the stomach, which makes gastric juice more harmful. Finally, smoking can directly damage the esophagus, making it less able to resist further damage from refluxing materials.

Smoking makes saliva life-threatening

Smoking tobacco reduces the amount of bicarbonate present in saliva. Bicarbonate is an acid neutralizing compound. Smoking cigarettes can turn saliva in the mouth into a potentially deadly cancer-promoting cocktail. Normally, saliva acts as a buffer that protects the lining of the mouth from harmful substances. Research shows that saliva can be poisoned by the chemicals found in cigarette smoke. They destroy its protective components, leaving a corrosive mixture that damages cells in the mouth and can lead to cancer. The mixture of saliva and smoke is actually more deadly to cells in the mouth than cigarette smoke alone.

Once exposed to cigarette smoke, normally healthy saliva not only loses its beneficial qualities, it becomes treacherous and actually helps destroy cells in the mouth and oral cavity. Cigarette smoke is not only harmful in itself, it can turn the body against itself. Saliva contains natural antioxidants, molecules that neutralize harmful free radicals – groups of unstable atoms capable of damaging DNA and triggering cancer. Cigarette smoke not only destroyed antioxidants, but created a potentially deadly cocktail of free radicals.

About 90% of people with oral cancer are smokers, and smokers are six times more likely than non-smokers to develop oral cancer. Additionally, users of smokeless tobacco, commonly known as chewing tobacco, are 50 times more likely to develop oral cancer.

Smoking and excess alcohol combined can significantly increase your risk of oral cancer. Some studies suggest that heavy drinkers who are also smokers are up to 100 times more likely to be diagnosed with oral cancer than those who don’t drink or smoke.

Smoking and peptic ulcers

Smoking appears to be a risk factor for the development, maintenance and recurrence of peptic ulcer disease. Smoking has an inconsistent effect on gastric acid secretion, but it has other effects on upper gastrointestinal function that may contribute to peptic ulcer pathogenesis. These include interference with the action of histamine-2 antagonists, acceleration of gastric emptying of fluids, promotion of duodenogastric reflux, inhibition of pancreatic bicarbonate secretion, reduction of flow mucosal blood and inhibition of mucosal prostaglandin production.

Smoking also increases the risk of Helicobacter pylori infection. These are bacteria commonly present in ulcers.

Since these effects are directly related to the act of smoking and smoking cessation is associated with rapid recovery of the respective functions, smokers will immediately benefit from stopping or reducing cigarette consumption.

Smoking and liver disease

Smoking affects the liver via 3 distinct mechanisms: toxic (both direct and indirect), immunological and oncogenic. The liver normally filters alcohol and other toxins from the blood. But smoking limits your liver’s ability to remove these toxins from your body. If the liver is not working as it should, it may not be able to process medications properly. When smoking is combined with excessive alcohol consumption, it worsens liver disease.

There is an association between smoking and the progression of fibrosis in chronic liver disease. Smoking is associated with accelerated development of hepatocellular carcinoma in patients with chronic hepatitis B or C virus infection.

Smoking negatively affects lung function, which increases physical limitations and may prevent liver transplantation. After liver transplantation, smoking is associated with several adverse outcomes, including an increased risk of de novo malignancy, vascular complications, and non-transplant-associated mortality.

The respiratory disease caused by the new coronavirus disease COVID-19 is a good example of the complex interaction between the lungs and the liver. It is evident that smoking has significant negative effects on a multitude of liver diseases and smoking cessation for patients should be a priority.

Smoking and Crohn’s disease

Crohn’s disease is a chronic inflammatory bowel disease. It causes inflammation of the digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition. This inflammation often spreads to the deeper layers of the intestine. Crohn’s disease can be both painful and debilitating, and can sometimes lead to life-threatening complications.

This disease is an autoimmune disease of the digestive tract. People who smoke are more likely to have Crohn’s disease than those who don’t smoke. Smoking can make Crohn’s disease worse. People with Crohn’s disease who smoke may find that they have more severe symptoms and complications such as strictures and fistulas, have more flare-ups, need more steroids and stronger medications such as immunosuppressants and biologics. Sometimes these drugs are not as effective in smokers, are more likely to need surgery, and are more likely to need to return for another surgery.

Women who smoke are more likely to develop Crohn’s disease and require surgery than men who smoke. Smoking has also been shown to be associated with disease location. Smokers tend to have Crohn’s disease in the small intestine (small intestine) rather than the colon (large intestine).

Tobacco smoke contains over a thousand different chemicals, including nicotine, carbon monoxide and free radicals. Smoking can affect the gut in several ways: it can weaken intestinal defenses, decrease blood flow in the intestines, or cause changes in the immune system that lead to inflammation.

Children and unborn babies exposed to passive smoking may be more susceptible to developing Crohn’s disease. Smoking during pregnancy is not recommended.

In non-smokers, Crohn’s disease appears to be milder. Quitting smoking is beneficial for people with Crohn’s disease. Guidelines for people with Crohn’s disease strongly recommend that people with Crohn’s disease do not smoke.

Smokers also seem to have a greater need for some of the stronger forms of medical treatment such as immunosuppressive drugs. People who quit smoking are less likely to need repeat surgery compared to people who continue to smoke after surgery. Reducing the amount you smoke can have a positive effect on symptoms.

Smoking and gallstones

Smoking is thought to affect the hepatobiliary system and has been linked to an increased risk of liver and gallbladder cancer. Some research suggests that smoking increases the risk of developing gallstones. Gallstones form when fluid stored in the gallbladder turns into a stone-like material. These can vary in size from a grain of sand to a pebble.

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