High-risk smoking in the United States: Nicotine staining predicts increased colonic adenomas and advanced adenomas on colonoscopy

Christopher Bouvette; Justin Kosirog; Bryce Yohannan; Alyssa Grossen; Ijlal Akbar Ali; Mohammad Madhoun

doi:10.1016/j.ypmed.2024.107950

High-risk smoking in the United States: Nicotine staining predicts increased colonic adenomas and advanced adenomas on colonoscopy

Prev Med. 2024 May:182:107950. doi: 10.1016/j.ypmed.2024.107950. Epub 2024 Apr 6.

Authors

Christopher Bouvette¹, Justin Kosirog², Bryce Yohannan³, Alyssa Grossen⁴, Ijlal Akbar Ali⁵, Mohammad Madhoun⁶

Affiliations

¹ Veterans Affairs Medical Center, 921 NE 13(th) Street, Oklahoma City, OK, USA; Department of Medicine, University of Oklahoma College of Medicine, 800 Stanton L. Young Boulevard AAT 6300, Oklahoma City, OK, USA. Electronic address: christopher-bouvette@ouhsc.edu.
² Veterans Affairs Medical Center, 921 NE 13(th) Street, Oklahoma City, OK, USA; Section of Digestive Diseases and Nutrition, Department of Medicine, University of Oklahoma College of Medicine, 800 Stanton L. Young Boulevard AAT 7400, Oklahoma City, OK, USA.
³ Veterans Affairs Medical Center, 921 NE 13(th) Street, Oklahoma City, OK, USA; Section of Digestive Diseases and Nutrition, Department of Medicine, University of Oklahoma College of Medicine, 800 Stanton L. Young Boulevard AAT 7400, Oklahoma City, OK, USA. Electronic address: bryce-yohannan@ouhsc.edu.
⁴ Veterans Affairs Medical Center, 921 NE 13(th) Street, Oklahoma City, OK, USA; Section of Digestive Diseases and Nutrition, Department of Medicine, University of Oklahoma College of Medicine, 800 Stanton L. Young Boulevard AAT 7400, Oklahoma City, OK, USA. Electronic address: alyssa-grossen@ouhsc.edu.
⁵ Veterans Affairs Medical Center, 921 NE 13(th) Street, Oklahoma City, OK, USA; Section of Digestive Diseases and Nutrition, Department of Medicine, University of Oklahoma College of Medicine, 800 Stanton L. Young Boulevard AAT 7400, Oklahoma City, OK, USA. Electronic address: ijlalakbar-ali@ouhsc.edu.
⁶ Veterans Affairs Medical Center, 921 NE 13(th) Street, Oklahoma City, OK, USA; Section of Digestive Diseases and Nutrition, Department of Medicine, University of Oklahoma College of Medicine, 800 Stanton L. Young Boulevard AAT 7400, Oklahoma City, OK, USA. Electronic address: mohammad-madhoun@ouhsc.edu.

PMID: 38583603
DOI: 10.1016/j.ypmed.2024.107950

Abstract

Background: Smoking is linked with numerous adverse health effects. Nicotine staining on fingers or teeth is thought to suggest active or heavy smoking. The significance of nicotine staining within gastroenterology remains unclear.

Aim: We set out to establish the predictive value of nicotine staining for adenomas and advanced adenomas.

Methods: This was a cross-section study of patients who underwent colonoscopy at the Oklahoma City Veterans Affairs Medical Center from November 2019 to November 2020. Pre-procedure patient survey ascertained current smoking status. Endoscopist performed a nicotine staining survey upon completion of the respective colonoscopy. Chart review allowed determination of patient demographics, comorbidities, and colonoscopy findings. Patients without smoking history were assigned to a control cohort. We applied one-way analysis of variance when comparing the mean of continuous variables and the Chi-square test when comparing categorical variables. Lastly, we used stepwise logistic regression to estimate adjusted odds ratio. A p-value <0.05 was considered statistically significant.

Results: Compared to those without smoking history or evidence of nicotine staining, patients with positive nicotine staining were older (P = 0.03), leaner (P < 0.0001), and more likely to have chronic obstructive pulmonary disease (P < 0.0001) or history of alcohol abuse (P < 0.0001). Furthermore, presence of nicotine staining independently predicted increased likelihood of multiple adenomas (OR 1.5, 95% CI [1.2-1.9]) and advanced adenomas (OR 1.6, 95% CI [1.2-2.2]).

Conclusion: This marks the first investigation of nicotine staining within gastroenterology. We have demonstrated that the presence of nicotine staining independently predicts numerous adenomas and advanced adenomas.

Keywords: Cigarette smoking; Colonoscopy; Colorectal cancer; High-risk smoking; Nicotine staining; Smoking history.