The Association Between Electronic Cigarette Smoking and Gastroesophageal Reflux Disease: A Population-Based Study

Abstract

Introduction: Gastroesophageal reflux disease (GERD) is associated with lifestyles. Electronic cigarette (e-cig) smoking is a new trend of lifestyle. Yet, the relationship between e-cig smoking and GERD among adult urban population. Methods: A cross-sectional study was conducted among 267 adult urban people in Cirebon, West Java, Indonesia. A self-administered questionnaire was given. It consisted demographic characteristics, e-cig smoking status, GERD-related symptom, and validated GERD questionnaire (GERDQ). Data were analyzed using descriptive statistics and chi-square test. This study has been approved by an ethical committee. Results: The median age of the subjects was 24.0 years old. E-cig smoking was frequent (74.2%) with the median duration 2.0 years. The median of its dose was 30.0 mL weekly. The prevalence of GERD in this study was 9.4%. The e-cig smoking was positively associated with regurgitation (PR= 1.388; 95%CI: 1.284-1.500; p=0.006), but it was negatively associated with GERD (PR= 0.334; 95%CI: 0.144-0.772; p=0.008). Conclusion: The prevalence of e-cig smoker in US is 15%, in UK 10%, in Canada 4%, and in Australia 2%.1-2 The prevalence of e-cig smoker in this study is high. The differences can be caused by different definition and scope of population used in the studies. E-cig smoking is still a controversial issue. Some in the community have embraced e-cig smoking as a safer alternative to conventional cigarettes, further as a smoking cessation method.1,3 Yet, the hazards of e-cig smoking are still unknown. S. A. Meo, et al.,4 reported that e-cig smoking can cause nausea and vomiting. Our study revealed that e-cig smoking was clinically associated with regurgitation. It was assumed that those effects are due to nicotine toxicity via inhalation delivery system. But, our study also showed that 2-year e-cig smoking is statistically negative association with GERD. There are limitations in this study. First, study design we used in this study was cross-sectional. We propose cohort study in the future studies evaluating the association between e-cig smoking and GERD. Second, relatively short duration of e-cig consuming might be less provoking the GERD. Third, we did not evaluate other variables enabling them as confounding factors. As a conclusion, this first population-based study showed that e-cig smoking is associated with regurgitation, but statistically it is negatively associated with GERD in adult urban population. Further studies are needed to evaluate this association.