Snus Use Is Not Associated with Gastrointestinal Problems

A new study (abstract here) published in the European Journal of Epidemiology finds that snus use in Sweden is not associated with gastrointestinal (GI) problems.

A detailed GI symptoms questionnaire was distributed to 3,000 adults age 18 to 80 years in the northern Swedish cities of Kalix and Haparanda. Questions concerned gastroesophageal reflux (GER), dyspepsia (pain above the stomach and/or nausea and feeling uncomfortably full after a meal), irritable bowel syndrome (IBS) and other conditions.

About 1,000 survey respondents were subjected to endoscopic exams of their upper GI tracts, searching for ulcers of the esophagus, stomach and small intestine and for evidence of infection by Helicobacter pylori (bacteria which can cause stomach ulcers). Snus users (n = 96), smokers (n = 165) and dual users (n = 22) were compared with non-users (n = 432).

The percentages of snus users reporting GI symptoms were no different than those among non-users. In contrast, smokers were more likely to report dyspepsia (OR = 1.6, 95% CI = 1.1 – 2.2), and dual users were more likely to report dyspepsia (OR = 2.8, CI = 1.1 – 7.3) and IBS (OR = 3.3, CI = 1.3 – 8.2).

With respect to the endoscopy findings, snus users were no more likely than non-users to have ulcers of the esophagus, stomach or small intestine. Smokers were more likely to have peptic ulcer disease (OR = 2.3, CI = 1.0 – 5.2). The published paper presents detailed findings of numerous other minor studies that were performed. Compared with non-users, neither snus users nor smokers had elevated rates of Helicobacter infections.

It is widely known that Swedish snus users place the tobacco in their upper lip, which results in minimal tobacco juice production, eliminating the need to spit. But a small amount of tobacco extract is swallowed, causing some users to worry about potential effects on the GI tract. This study offers reassurance that snus use is not associated with any significant GI symptoms or disorders.