TOBACCO AND COMMON ABDOMINAL DISORDERS

1. TOBACCO AND COMMON ABDOMINAL DISORDERS Mini-Lecture 1 Module: Tobacco and the Gastrointestinal System

2. Objectives of the Mini Lecture GOAL OF MINI LECTURE: Provide students with knowledge about the harmful effects of smoking on the digestive system. LEARNING OBJECTIVES • To understand how tobacco causes GI diseases. • To understand the relationship between tobacco use and gastric ulcer, gastro-esophageal reflux, and liver disease. • To understand the relationship between smoking and constipation. • To understand how and why to offer tobacco cessation in GI disorders.

3. Contents Core Slides • How Tobacco Causes GI Diseases • Tobacco and Gastric Ulcer • Gastro-esophageal Reflux • Tobacco and Liver Disease • Smoking and Constipation • Tobacco Cessation in GI Disorders Optional Slides • Tobacco and Crohn’s Disease • Tobacco and Gall Stones

4. CORE SLIDES Tobacco and Common Abdominal Disorders Mini-Lecture 1 Module: Tobacco and the Gastrointestinal System

5. How Tobacco Causes GI Diseases1 • Decreases total neck-cell mucus volume • Increases production of platelet activating factor (PAF) • Decreases angiogenesis in gastric mucosa → arrests cell renewal • Inhibits gastric mucosal cell proliferation 1. Maity et al. 2003

6. Tobacco and Gastric Ulcer1 • Smokers at increased risk • Induces and potentiates ulceration • Increases risk of H. pylori infection • Potentiates ulceration by alcohol, NSAIDS, etc. • Poor and delayed ulcer healing http://www.lifespan.org/adam/graphics/images/en/17192.jpg 1. National Digestive Diseases Information Clearinghouse (NDDIC, a service of NIH) 2006

7. Gastro-esophageal Reflux1 • Weakens the lower esophageal sphincter • Allows stomach acid to flow into the esophagus http://cdn-write.demandstudios.com/upload//1000/500/60/1/11561.jpg 1. National Digestive Diseases Information Clearinghouse (NDDIC, a service of NIH) 2006

8. Tobacco and Liver Disease1 • Impairs liver’s ability to process drugs, alcohol, and other toxins • Dose of medication needed to treat any illness affected • Worsens liver disease associated with alcohol http://hepatitisguide.info/images/liver_disease/liver_disease_250x251.jpg 1. National Digestive Diseases Information Clearinghouse (NDDIC, a service of NIH) 2006

9. Smoking and Constipation • Morning cigarette used to stimulate bowel movement in some cultures.1 • Patients may complain of constipation after quitting. • Doctor should offer anticipatory advice about constipation to patients who are quitting. 1. Nichter et al. 2004

10. Tobacco Cessation in GI Disorders • All patients with GI symptoms should be asked about their tobacco use. • Evidence suggests cessation is likely to be beneficial. • Provide assistance and referral. • Undertake more research.

11. OPTIONAL SLIDES Tobacco and Common Abdominal Disorders Mini-Lecture 1 Module: Tobacco and the Gastrointestinal System

12. Tobacco and Crohn’s Disease1 • Higher risk of developing Crohn's disease • Higher rate of relapse, repeat surgery and the need for drug therapy • Lowers intestinal defenses http://medicineworld.org/images/blogs/1-2009/crohns-disease-55699230.jpg 1. National Digestive Diseases Information Clearinghouse (NDDIC, a service of NIH) 2006

13. Tobacco and Gall Stones1 • Increases the risk of developing gallstones • Risk higher for women http://images.medicinenet.com/images/illustrations/gallstones.jpg 1. National Digestive Diseases Information Clearinghouse (NDDIC, a service of NIH) 2006

14. The most important health message a doctor can give to patients is to quit smoking.