Effect of Electronic Cigarettes on the Gastrointestinal System

Introduction: In the United States, the use of electronic cigarettes (EC) has seen an exponential rise with 12.6% of adults using an EC at least once in their lifetime, with use differing by age, sex, and race. The level of nicotine exposure of EC is highly variable with its liquids containing 14.8-87.2 mg/ml of nicotine. Its use has been documented to be associated with adverse effects on the respiratory, nervous, cardiovascular, and gastrointestinal (GI) systems. Common adverse effects on the GI system include xerostomia, oral mucositis, tongue discoloration, gingivitis, gum bleeding, nausea, vomiting, gastric burning, and altered bowel habits. Methods: A retrospective review of the National Health and Nutrition Examination Survey (NHANES) data from 2015-16 was conducted. Data regarding the use of EC and a history of vomiting and diarrhea over a period of 30 days was analyzed using SAS 9.4 (2013; SAS Institute Inc., Cary, North Carolin, United States). Additionally, data regarding age, gender, and income were also analyzed. A p-value of <0.05 was considered statistically significant. Continuous variables were analyzed using the two-sample t-test, and categorical variables were analyzed using the Chi-Square test. Results: A total of 944 participants were included in the study. Of these, 261 participants (males 62.84%) used EC at least one day and 683 participants (males 54.76%) never used EC, during the preceding 30 days. Amongst EC users (n=261), 10.73% had a stomach or intestinal illness manifesting as vomiting or diarrhea that started during those 30 days compared to 8.64% who never used EC during the same period (n=683). However, the results did not reach statistical significance (p = 0.3208) Conclusion: Conflicting views exist regarding the effects of EC on the GI tract. Our study demonstrated an association between EC consumption and vomiting and diarrhea. The study results are to be viewed by taking into consideration the limitations of a smaller sample, shorter duration, comorbidities, and undefined nicotine content in the EC. Although recent studies have shown no effect of EC on the oral or gut microbiota, our study findings could be attributed to EC-induced alteration of motility or irritation of the GI tract. However, further studies are required to establish a causal relationship and enunciate the mechanism by which EC components affect the GI tract. Careful consideration and diligence about the health effects of ECs are required before it is assumed to be safe as a cigarette substitute or as a means of smoking cessation.