2995 Gastrointestinal Upset: Could E-Cigarettes Be the Cause?

Abstract

INTRODUCTION: In the United States, use of electronic cigarette (EC) has seen an exponential rise with 12.6% of adults using an EC at least once in their lifetime, with use differing by age, sex, and race. The level of nicotine exposure with EC is highly variable with its liquids containing 14.8 to 87.2 mg/ml of nicotine. Its use has been documented to be associated with adverse effects on the respiratory, nervous, cardiovascular, and gastrointestinal (GI) system. Common adverse effects on the GI system include xerostomia, oral mucositis, tongue discoloration, gingivitis, gum bleeding, nausea, vomiting, heartburn, and altered bowel habits. METHODS: A retrospective review of the National Health and Nutrition Examination Survey (NHANES) data between 2015-16 was conducted. Data regarding the use of EC and a history of vomiting and diarrhea over a period of 30 days were analyzed. Additionally, data regarding age and sex were analyzed. A P-value of < 0.05 was considered statistically significant. Continuous and categorical variables were analyzed using the two-sample t-test and the Chi-Square test, respectively. All the analyses were done in SAS 9.4 (SAS Institute, Cary, NC). RESULTS: A total of 944 participants were included in the study. Of these, 261 participants (males 62.84%) used EC at least one day and 683 participants (males 54.76%) never used EC, during the preceding 30 days. Amongst EC users (n = 261), 10.73% had a stomach or intestinal illness manifesting as vomiting or diarrhea that started during those 30 days compared to 8.64% who never used EC during the same period (n = 683). However, the results did not reach statistical significance (P = 0.3208). CONCLUSION: Conflicting views exist regarding the effects of EC on the GI tract. Our study demonstrated an association between EC consumption and vomiting and diarrhea. The study results are to be viewed taking into consideration the limitations of a smaller sample, shorter duration, existing comorbidities, and undefined nicotine content in the EC. Although recent studies have shown no effect of EC on the oral or gut microbiota, our study findings could be attributed to EC induced alteration of motility or irritation of the GI tract. However, further studies are required to establish a causal relationship and enunciate the mechanism by which EC components affect the GI tract. Careful consideration and diligence about the health effects of EC is required before it is assumed to be safe as a cigarette substitute or as a means of smoking cessation.