IBS, Smoking, E-cigarettes and Nicotine

IBS and other diseases of the digestive system, including diverticular disease, are affected by cigarette smoking. Tobacco smoking is rapidly being replaced by the use of e-cigarettes known as ‘vaping’. This system is clamed to be safer than tobacco cigarettes, giving the pleasurable effects of nicotine with only trivial side effects. However, the pharmacological effects of nicotine are still relevant to all nicotine delivery systems.

This article appeared in Gut Reaction, the magazine of the IBS Network, Issue 93, Oct 2014

IBS sufferers are well aware that diet and the passage of food residues through the gut can influence their problems. Similarly, worry and stress affect the digestive system through nerve connections between the head brain and gut brain. Less attention is paid to substances which reach the bowel through it’s blood supply to modify nerve and muscle behaviour. Drugs and their side-effects are an example.

Cigarette smoking delivers many chemicals into the blood stream as well as direct action on the lungs from inhaling burning tobacco smoke. Carcinogenic chemicals circulating in the body also increase cancer risk in other areas. The many types of tobacco products and delivery systems available are aimed at getting enough nicotine into the brain to stop withdrawal symptoms – such is the nature of addiction. However, that nicotine is also circulating round the body and affecting the digestive tract (1).

  • Current smoking and female gender were associated with IBS in Korea (2).
  • Smoking was a significant factor in post-infective IBS (3,4).
  • Current smokers had more persistent microscopic colitis and IBS symptoms and past smokers had more transient problems compared with non-smokers (5).
  • Smoking was associated with bloating (6).
  • Brietinger et al. (7) reported that nicotine inhibited 5HT3 receptors; these are important in gut motility, suggesting the possibility of interaction with drugs or migraine effects.
  • After a study of IBS in military cadets, researchers suggested that smoking cessation was a very effective tool in managing IBS (8).

IBS research does not always report the smoking habits of participants. Smoking has a negative effect on other intestinal diseases, for example, gastric ulcers, Crohn’s disease, acid reflux, diverticular disease and appendicitis. Cardiovascular, cerebral and bronchial systems are also affected (1,9,10) because of changes in the muscles and nerves of hollow organs, particularly blood vessels. This complex pharmacology gives a possible benefit for Ulcerative Colitis but its use is prevented by the addiction side effect. These are the effects of the drug nicotine from any source not just from tobacco cigarettes and have been known for decades (11). Manufacturers and retailers of e-cigarettes and their Trade Association promote nicotine in their products as a trivial risk compared with tobacco smoke. They are deluding their customers.

The effects of nicotine can vary from one person to the next. It’s breakdown in the liver depends on gender, genetic and ethnic differences. Nicotine actions on the gut are also complex. In single doses it is a stimulant, in the chronic doses of addiction it disables nerve control of the digestive system and will reduce it’s blood supply. Stopping smoking can change the activity of the gut almost as if the gut brain was addicted and having withdrawal symptoms. A sudden stop in smoking can be difficult, a gradual reduction in nicotine intake is an alternative way to get the lifetime benefits from giving up smoking. Support helps and is available within the NHS.

Skin patches, sprays etc avoid the by-products of burnt tobacco and give controlled dosing of nicotine when trying to give up smoking. The cleverly contrived e-cigarettes might do the same if a genuine desire to overcome addiction was the reason for their use, but smokers use them to achieve nicotine levels the same as from tobacco cigarettes (12). A report (13) suggests they are used by smokers to replace cigarettes because they are cheaper and can be used in smoke-free situations. They also overcome the “empty hands” feeling. Their use has increased explosively. Governments, taxation, safety, quality control and health agencies have been caught napping.

Nicotine is a very toxic drug. In the USA, calls to poison centres about e-cigarettes have increased rapidly and the majority of these relate to 0-5 year olds (14). Fruity flavours and colourful labels do not reflect the danger within e-cigarette refill liquids. It has been estimated that 5ml of a 1.8% nicotine solution could be lethal to a 90 Kg person (15). These bottles should be labelled POISON. Be careful with their use near children.

© 2014 Mary Griffiths


1         Massarrat S. Smoking and gut. Arch Iran Med. 2008, 11, 293.

2         Nam SY et al. Prevalence and risk factors of irritable bowel syndrome in healthy screenee undergoing colonoscopy and laboratory tests. J Neurogastroenterol Motil. 2010, 16, 47.

3         Spiller R, Garsed K. Infection, inflammation, and the irritable bowel syndrome. Dig Liver Dis. 2009, 41, 844.

4         Parry SD et al. Factors associated with the development of post-infectious functional gastrointestinal disease: does smoking play a role? Eur J Gastroenterol Hepatol. 2005, 17, 1071.

5         Roth B et al. Smoking and alcohol habits in relation to the clinical picture of women with microscopic colitis compared to controls. BMC Womens Health. 2014, 14,16.

6         Tuteja AK et al. Abdominal bloating in employed adults: prevalence, risk factors, and association with other bowel disorders. Am J Gastroenterol. 2008, 103, 1241.

7         Breitinger HG et al. Inhibition of the serotonin 5-HT3 receptor by nicotine, cocaine, and fluoxetine investigated by rapid chemical kinetic techniques. Biochemistry 2001, 40, 8419.

8         Kang SH et al. The effects of lifestyle modification on symptoms and quality of life in patients with irritable bowel syndrome: a prospective observational study. Gut Liver 2011, 5, 472.

9         Kent-Man Chu et al. Nicotine and gastrointestinal disorders: its role in ulceration and cancer development. Current Pharmaceutical Design 2013, 19, 5.

10     Oldmeadow C et al. Investigation of the relationship between smoking and appendicitis in Australian twins. Ann Epidemiol 2008, 18, 631.

11     A report of the surgeon general. U.S. department of health and human services. The health consequences of smoking for women. 1980.

12     Schroeder MJ & Hoffman AC. Electronic cigarettes and nicotine clinical pharmacology. Tob Control 2014, 23 Suppl 2, ii30.

13     Action on Smoking and Health. Fact sheet, Use of electronic cigarettes in Great Britain. April 2014. www.ash.org.uk

14     Vakkalanka JP et al. Epidemiological trends in electronic cigarette exposures reported to U.S. poison centers. Clin Toxicol (Phila) 2014, 52, 542.

15     Bassett RA et al. Nicotine poisoning in an infant. N Engl J Med. 2014, 370, 2249.

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