Role of smoking in functional dyspepsia and irritable bowel syndrome: three random population-based studies

Aliment Pharmacol Ther. 2021 Jul;54(1):32-42. doi: 10.1111/apt.16372. Epub 2021 May 13.

Nicholas J Talley 1 2, Nicholas Powell 3, Marjorie M Walker 1 2, Mike P Jones 2 4, Jukka Ronkainen 5 6, Anna Forsberg 7, Lars Kjellström 8, Per M Hellström 9, Pertti Aro 10, Bengt Wallner 11, Lars Agréus 12, Anna Andreasson 4 7 13


Author information

  • 1Faculty of Health and Medicine, University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, Australia, 2305, Australia.
  • 2NHMRC Centre for Research Excellence in Digestive Health, Australia.
  • 3Division of Digestive Disease, Imperial College, London, UK.
  • 4Department of Psychology, Macquarie University, North Ryde, NSW, Australia.
  • 5Center for Life Course Health Research, University of Oulu, Oulu, Finland.
  • 6Primary Health Care Centre, Tornio, Finland.
  • 7Department of Medicine Solna, Karolinska Institutet, Solna, Sweden.
  • 8Gastromottagningen City, Stockholm, Sweden.
  • 9Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
  • 10Arokero OY, Tornio, Finland.
  • 11Department of Surgical and Perioperatve Sciences, Umeå University, Umeå, Sweden.
  • 12Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
  • 13Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden.


Background: It is uncertain if functional dyspepsia (FD) or irritable bowel syndrome (IBS) are linked to smoking, and smoking cessation is not part of the routine advice provided to these patients.

Aim: To assess if smoking is an independent risk factor for FD and IBS.

Methods: Three population-based endoscopy studies in Sweden with 2560 community individuals in total (mean age 51.5 years, 46% male). IBS (14.9%), FD (33.5%), and associated symptoms were assessed using the validated abdominal symptom questionnaire, and smoking (17.9%) was obtained from standardised questions during a clinic visit. The effect of smoking on symptom status was analysed in an individual person data meta-analysis using mixed effect logistic regression, adjusted for snuffing, age and sex.

Results: Individuals smoking cigarettes reported significantly higher odds of postprandial distress syndrome (FD-PDS) (OR 10-19 cig/day = 1.42, 95% CI 1.04-1.98 P = 0.027, OR ≥20 cig/day = 2.16, 95% CI 1.38-3.38, P = 0.001) but not epigastric pain. Individuals smoking 20 or more cigarettes per day reported significantly higher odds of IBS-diarrhoea (OR = 2.40, 95% CI 1.12-5.16, P = 0.025), diarrhoea (OR = 2.01, 95%CI 1.28-3.16, P = 0.003), urgency (OR = 2.21, 95%CI 1.41-3.47, P = 0.001) and flatus (OR = 1.77, 95%CI 1.14-2.76, P = 0.012) than non-smokers. Smoking was not associated with IBS-constipation or IBS-mixed.

Conclusion: Smoking is an important environmental risk factor for postprandial distress syndrome, the most common FD subgroup, with over a twofold increased odds of PDS in heavy smokers. The role of smoking in IBS-diarrhoea, but not constipation, is also likely important.



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