{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T19:35:14Z","timestamp":1761766514523,"version":"3.37.3"},"reference-count":39,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2019,4,18]],"date-time":"2019-04-18T00:00:00Z","timestamp":1555545600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Health and welfare surcharge of tobacco products","award":["MOHW108-TDU-B-212-114016"],"award-info":[{"award-number":["MOHW108-TDU-B-212-114016"]}]},{"name":"Kaohsiung Medical Univerisity Hospital","award":["KMUH107-6R01"],"award-info":[{"award-number":["KMUH107-6R01"]}]},{"DOI":"10.13039\/501100004663","name":"Taiwan's Ministry of Science and Technology","doi-asserted-by":"crossref","award":["MOST 105-2314-B-037-019-MY3"],"award-info":[{"award-number":["MOST 105-2314-B-037-019-MY3"]}],"id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Kaohsiung J of Med Scie"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>This study examines the effects of environmental hazards, including tobacco, alcohol\/alcohol flush response, areca nut, and <jats:italic>Helicobacter pylori<\/jats:italic> (<jats:styled-content style=\"fixed-case\"><jats:italic>H pylori<\/jats:italic><\/jats:styled-content>) infection on upper digestive diseases. This is a multi\u2010hospital\u2010based endoscopy\u2010survey cross\u2010sectional study. Subjects were received upper endoscopies in outpatient clinics at four hospitals in Taiwan between 2008 and 2013. Biopsy\u2010based methods or urea breath test were used confirm the status of <jats:styled-content style=\"fixed-case\"><jats:italic>H pylori<\/jats:italic><\/jats:styled-content> infection. In total, 8135 subjects were analyzed. Higher cumulative amounts of alcohol consumption were at higher risk of Barrett's esophagus and esophageal squamous cell carcinoma (ESCC), higher cumulative amounts of tobacco consumption were at higher risk of peptic ulcer, and higher cumulative amounts of areca nut consumption were at higher risk of duodenitis. Alcohol flush response was significant risk for reflux esophagitis and Barrett's esophagus (adjusted odds ratio [aOR]\u2009=\u20091.18 and 1.32, 95% confidence interval [CI]\u2009=\u20091.07\u20101.31 and 1.06\u20101.65, respectively). <jats:styled-content style=\"fixed-case\"><jats:italic>H pylori<\/jats:italic><\/jats:styled-content> infection was inversely associated with ESCC risk (aOR\u2009=\u20090.20, 95% CI\u2009=\u20090.10\u20100.40). In addition, <jats:styled-content style=\"fixed-case\"><jats:italic>H pylori<\/jats:italic><\/jats:styled-content> infection was consistently and significantly risk factors for gastrointestinal diseases, including peptic ulcer, gastric adenocarcinoma, and duodenitis (aOR\u2009=\u20095.51, 1.84, and 2.10, 95% CI\u2009=\u20094.85\u20106.26, 1.03\u20103.26, and 1.71\u20102.56, respectively). Besides the cumulative risk of alcohol, tobacco, and areca nut for Barrett's esophagus, ESCC, and peptic ulcer, respectively, presence of facial flushing was the significant risk for reflux esophagitis and Barrett's esophagus. <jats:styled-content style=\"fixed-case\"><jats:italic>H pylori<\/jats:italic><\/jats:styled-content> infection was positively associated with peptic ulcer, gastric adenocarcinoma, and duodenitis, but inversely associated with ESCC.<\/jats:p>","DOI":"10.1002\/kjm2.12071","type":"journal-article","created":{"date-parts":[[2019,4,19]],"date-time":"2019-04-19T05:59:16Z","timestamp":1555653556000},"page":"341-349","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Risks of substance uses, alcohol flush response, <i>Helicobacter pylori<\/i> infection and upper digestive tract diseases\u2014An endoscopy cross\u2010sectional 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