Thursday, November 10, 2016

Snus Not Associated with Gastroesophageal Reflux, Says Norwegian Study

Norwegian researchers report that snus users had lower risks for gastroesophageal reflux symptoms (GERS) than never users (abstract here). This builds on Swedish findings of six years ago that snus use was not linked to gastrointestinal problems (here). 

The new study, published in the Scandinavian Journal of Gastroenterology, used surveys from 2006 to 2009 in Norway’s large rural North TrΓΈndelag County.  The authors “hypothesized that snus use would increase the risk of GERS.  However, the overall result was that snus use seems to protect against GERS.”  They concluded, “Compared to never snus users, daily snus users had a reduced risk of GERS (OR = 0.77, 95% confidence interval [CI] = 0.64–0.93).”

Surprised by their data, the authors questioned whether they were seeing “reverse causality”, where snus users who developed GERS may have quit, shifting GERS to “former” snus users.  The researchers did find that former users had an insignificant elevation (OR = 1.20, CI = 1.00 – 1.46).  However, while higher snus consumption should be associated with higher risk of GERS, this study found the opposite.  The lowest consumption level (less than two boxes a month) was associated with a 41% increase in GERS, but higher consumption levels were not associated with increases.

GERS rates were significantly elevated in two groups of snus users: those who also smoked (OR = 2.26, CI = 1.17 – 4.35) and those who had switched from cigarettes (OR = 1.50, CI = 1.13 – 1.99).  Smoking is a factor in some GERS studies.  Two years ago, some of the current study’s authors published research asserting that “Tobacco smoking increases the risk of…GERS,” and that quitting resulted in symptom improvement in selected survey participants.  It is surprising that this work is not referenced in the new study, as it is directly relevant.

Snus users, rest easy.  Your habit involves little to no risk of reflux.

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