Smoking and Your Digestive System :- Cigarette smoking
causes a variety of life-threatening diseases, including lung
cancer, emphysema, and heart disease. An estimated 430,000 deaths
each year are directly caused by cigarette smoking. Smoking is
responsible for changes in all parts of the body, including the
digestive system. This fact can have serious consequences because
it is the digestive system that converts foods into the nutrients
the body needs to live.
Current estimates indicate that about one-third of all adults
smoke. And, while adult men seem to be smoking less, women and
teenagers of both sexes seem to be smoking more. How does smoking
affect the digestive system of all these people?
Harmful Effects
Smoking has been shown to have harmful effects on all parts of the
digestive system, contributing to such common disorders as
heartburn and peptic ulcers. It also increases the risk of Crohn's
disease and possibly gallstones. Smoking seems to affect the
liver, too, by changing the way it handles drugs and alcohol. In
fact, there seems to be enough evidence to stop smoking solely on
the basis of digestive distress.
Heartburn
Heartburn is common among Americans. More than 60 million
Americans have heartburn at least once a month, and about 15
million have it daily.
Heartburn happens when acidic juices from the stomach splash into
the esophagus. Normally, a muscular valve at the lower end of the
esophagus, the lower esophageal sphincter (LES), keeps the acid
solution in the stomach and out of the esophagus. Smoking
decreases the strength of the esophageal valve, thereby allowing
stomach acids to reflux, or flow backward into the esophagus.
Smoking also seems to promote the movement of bile salts from the
intestine to the stomach, which makes the stomach acids more
harmful. Finally, smoking may directly injure the esophagus,
making it less able to resist further damage from refluxed fluids.
Peptic Ulcer
A peptic ulcer is an open sore in the lining of the stomach or
duodenum, the first part of the small intestine. The exact cause
of ulcers is not known. A relationship between smoking cigarettes
and ulcers, especially duodenal ulcers, does exist. The 1989
Surgeon General's report stated that ulcers are more likely to
occur, less likely to heal, and more likely to cause death in
smokers than in nonsmokers.
Why is this so? Doctors are not really sure, but smoking does seem
to be one of several factors that work together to promote the
formation of ulcers.
For example, some research suggests that smoking might increase a
person's risk of infection with the bacterium Helicobacter pylori
(H. pylori). Most peptic ulcers are caused by this bacterium.
Stomach acid is also important in producing ulcers. Normally, most
of this acid is buffered by the food we eat. Most of the
unbuffered acid that enters the duodenum is quickly neutralized by
sodium bicarbonate, a naturally occurring alkali produced by the
pancreas. Some studies show that smoking reduces the bicarbonate
produced by the pancreas, interfering with the neutralization of
acid in the duodenum. Other studies suggest that chronic cigarette
smoking may increase the amount of acid secreted by the stomach.
Whatever causes the link between smoking and ulcers, two points
have been repeatedly demonstrated: People who smoke are more
likely to develop an ulcer, especially a duodenal ulcer, and
ulcers in smokers are less likely to heal quickly in response to
otherwise effective treatment. This research tracing the
relationship between smoking and ulcers strongly suggests that a
person with an ulcer should stop smoking.
Liver Disease
The liver is an important organ that has many tasks. Among other
things, the liver is responsible for processing drugs, alcohol,
and other toxins to remove them from the body. There is evidence
that smoking alters the ability of the liver to handle such
substances. In some cases, this may influence the dose of
medication necessary to treat an illness. Some research also
suggests that smoking can aggravate the course of liver disease
caused by excessive alcohol intake.
Crohn's Disease
Crohn's disease causes inflammation deep in the lining of the
intestine. The disease, which causes pain and diarrhea, usually
affects the small intestine, but it can occur anywhere in the
digestive tract. Research shows that current and former smokers
have a higher risk of developing Crohn's disease than nonsmokers
do. Among people with the disease, smoking is associated with a
higher rate of relapse, repeat surgery, and immunosuppressive
treatment. In all areas, the risk for women, whether current or
former smokers, is slightly higher than for men. Why smoking
increases the risk of Crohn's disease is unknown, but some
theories suggest that smoking might lower the intestine's
defenses, decrease blood flow to the intestines, or cause immune
system changes that result in inflammation.
Gallstones
Several studies suggest that smoking may increase the risk of
developing gallstones and that the risk may be higher for women.
However, research results on this topic are not consistent, and
more study is needed.
Can the damage be reversed?
Some of the effects of smoking on the digestive system appear to
be of short duration. For example, the effect of smoking on
bicarbonate production by the pancreas does not appear to last.
Within a half-hour after smoking, the production of bicarbonate
returns to normal. The effects of smoking on how the liver handles
drugs also disappear when a person stops smoking. However, people
who no longer smoke still remain at risk for Crohn's disease.
Clearly, this question needs more study.
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