University of Oulu

Talley, NJ, Powell, N, Walker, MM, et al. Role of smoking in functional dyspepsia and irritable bowel syndrome: three random population-based studies. Aliment Pharmacol Ther. 2021; 54: 32– 42.

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

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Author: Talley, Nicholas J.1,2; Powell, Nicholas3; Walker, Marjorie M1,2;
Organizations: 1University of Newcastle, Newcastle, Australia
2NHMRC Centre of Research Excellence in Digestive Health
3Division of Digestive Disease, Imperial College, London, UK
4NHMRC Centre for Research Excellence in Digestive Health, Australia
5Department of Psychology, Macquarie University, North Ryde, NSW, Australia
6Center for Life Course Health Research, University of Oulu, Oulu, Finland
7Primary Health Care Centre, Tornio, Finland
8Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
9Gastromottagningen City, Stockholm, Sweden
10Department of Medical Sciences, Uppsala University, Uppsala, Sweden
11Arokero OY, Tornio, Finland
12Department of Surgical and Perioperatve Sciences, Umeå University, Umeå, Sweden
13Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
14Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.5 MB)
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Language: English
Published: John Wiley & Sons, 2021
Publish Date: 2022-05-13


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.

Conclusions: 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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Series: Alimentary pharmacology and therapeutics
ISSN: 0269-2813
ISSN-E: 1365-2036
ISSN-L: 0269-2813
Volume: 54
Issue: 1
Pages: 32 - 42
DOI: 10.1111/apt.16372
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
3142 Public health care science, environmental and occupational health
Funding: he studies were supported by the Swedish Research Council, the Swedish Society of Medicine, Ersta Hospital (Sweden), Mag-tarmförbundet (Sweden), Norrbotten County Council (Sweden), Astra Zeneca R&D (Sweden), Orion Research Foundation (Finland), the Finnish Medical Foundation (Finland), the Finnish Society of Medicine Duodecim, Vappu and Oskari Yli-Perttula’s Foundation (Finland), Stockholm County Council (Sweden), the Medical Faculty of Uppsala University (Sweden), Karolinska Institutet, Uppsala County Council (Sweden), Astra Pharmaceutical and Olympus. The study sponsors were not involved in interpretation of data, study design, collection, analysis or interpretation of data, nor in the writing of or the decision to publish the report. NJT is supported by funding from the National Health and Medical Research Council (NHMRC) to the Centre for Research Excellence in Digestive Health and he holds an NHMRC Investigator grant. AA was supported by Ruth and Richard Julin foundation and Nanna Svartz foundation.
Copyright information: © 2021 John Wiley & Sons Ltd. This is the peer reviewed version of the following article: Talley, NJ, Powell, N, Walker, MM, et al. Role of smoking in functional dyspepsia and irritable bowel syndrome: three random population-based studies. Aliment Pharmacol Ther. 2021; 54: 32– 42, which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.