Effects of Smokeless Tobacco Use on the Upper Gastrointestinal Tract Mucosa: Gross and Histopathological Changes

Abstract

Background/Aim: Tobacco addiction is prevalent in South and Southeast Asia. This study aimed to assess upper gastrointestinal (GI) tract changes in smokeless tobacco (SLT) users through upper GI endoscopy (UGIE). Materials and Methods: A cross‑sectional observational study, including 108 SLT users and 90 controls who did not use tobacco, was conducted at an Indian tertiary care hospital from March 2022 to February 2023. Participants were categorized into three groups: Non‑SLT users (Group A), SLT users for <10 years (Group B), and SLT users for >10 years (Group C). UGIE and biopsies from the lower esophagus, stomach, and duodenum were performed, noting gross and pathological findings. Results: There were 89 males and 19 females. More than 60% of patients used SLT for more than 10 years. Grossly, erosive and ulcerative lesions of the esophagus and stomach were the most common findings. Barrett’s esophagus (14/108 patients) and esophageal neoplasms (5/108 patients) were found in 19/108 patients (17.59%). Common biopsy findings were chronic gastritis and duodenitis. Group C had a significantly high finding of gastric ulcers compared to other 2 groups. A total of 68/108 SLT users (62.96%) had Helicobacter pylori infection which was significantly higher compared to the controls (P < 0.05). Conclusion: Chronic SLT use was found to be associated with gross and histological changes in the upper GI tract such as chronic erosions, peptic ulcers, and neoplastic growths. UGIE must be done routinely in all these patients whenever they develop chronic dyspepsia for early diagnosis and management.