Alcohol drinking and cigarette smoking are well-known risk factors of upper digestive diseases, especially esophageal cancer. In Taiwan, betel quid chewing is another common risk factor. This study investigated the association between use of these three substances and upper digestive diseases. We collected data from 9,275 patients (>20 years) receiving esophagogastroduodenoscopy at four hospitals starting in 2008. Multiple imputation was used to handle missing questionnaire data and polynomial regressions were used to analyze the association between risk factors and clinical stage in the esophagus, stomach and duodenum. A random effects model was used to perform a meta-analysis and arrive at overall odds ratio and 95% confidence intervals. Participants who habitually smoked cigarettes, drank alcohol and chewed betel areca simultaneously had a 16.32-fold risk of esophageal cancer (95% CI =7.13-37.36), 2.93-fold risk of Barrette’s esophagus (95% CI =1.99-4.30), 1.59-fold risk of grade A-B erosive esophagitis (95% CI = 1.27-1.98), 1.97-fold risk of gastric ulcer (95% CI =1.50-2.59), 2.10-fold risk of duodenitis (95% CI =1.54-2.87) and 1.27-fold risk of duodenal ulcer (95% CI =1.00-2.69). Using more substances concurrently was associated with a significant trend at higher risk to develop those diseases. Meta-analysis also revealed the use of three substances came with a high risk of esophageal diseases. Our data concluded that cigarette smoking, alcohol drinking and betel quid chewing were associated with upper digestive tract disease. People who habitually used all three substances in Taiwan were at significantly higher risk of developing Barrette’s esophagus and esophageal cancer. This extremely high elevated risk of esophageal cancer alarms the clinical community and proper public health measures must be implemented in the clinical setting when identifying patients with exposure to the three risk factors.

Citation Format: Yun-Shiuan Chuang, Meng-Chieh Wu, Pi-i Lin, Fang-Run Yu, Yao-Kuang Wang, Deng-Chyang Wu, I-Chen Wu, Ming-Tsang Wu. Effects of alcohol consumption, cigarette smoking, betel quid chewing in upper digestive disease: A large cross-sectional study in Taiwan and meta-analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr LB-155. doi:10.1158/1538-7445.AM2017-LB-155