Transition of Care - Alcohol and Smoking

It is well known that drinking alcohol and smoking, including vaping, have a negative impact on several organs in the body. Due to various reasons described in this video, individuals with a congenital anomaly are often at increased risk of alcohol and smoking related health difficulties. Alcohol and smoking have an adverse respiratory impact. Individuals born with a congenital anomaly, such as congenital diaphragmatic hernia or esophageal atresia, are at increased risk of gastroesophageal reflux, which can be worsened by both alcohol and smoking. The respiratory impact of smoking is well known, in the case of congenitally underdeveloped alveoli, there is a direct cause of emphysema, which can result in chronic airway inflammation. The patient may cough or cough up sputum, and lung function may decline towards impairment in the long term. Smoking can cause pulmonary hypertension, and individuals with congenital anomalies may already be at increased risk of this due to their condition. It is worth mentioning that whilst the respiratory impact of smoking is well known, symptoms cannot be unequivocally linked, and they may signal a congenital lung disease. This should be considered when deciding on the patient's treatment plan. Alcohol and smoking also have an adverse impact on the esophagus and stomach. Alcohol and smoking both lower the tone of the oesophageal sphincter, thus increasing gastroesophageal reflux and subsequently, the risk of Barrett's esophagus and esophageal cancer. They are also both related to the development of esophageal squamous carcinoma. Individuals with congenital anomalies are often already at increased risk of such diseases, and therefore their risk is heightened. It should also be noted that those who have had funduplication surgery might face some difficulties vomiting in case of excessive alcohol consumption. The liver is also impacted by drinking alcohol. Drinking alcohol can result in the development of fatty liver disease, subsequent cirrhosis and liver failure due to portal hypertension. Patients with intestinal failure may be receiving parenteral nutrition for long periods, which has already been found to be linked to fatty liver disease. Smoking can also impact the urinary system, smoking can lead to arterial stenosis, which can impair kidney function. Kidney function can already be impaired for patients with congenital anomalies, such as intestinal failure and factual association, and therefore the impact may be heightened. Smoking is also linked to bladder cancer. Lastly, the bowel, smoking and alcohol can both lower the intestinal transit time. Which can have a negative impact for patients with intestinal failure, especially short bowel syndrome, and patients with anorectal malformations and Hirspring's disease, requiring complex bowel management. Alcohol can also alter the gut microbiome and may correlate with a higher incidence of early onset colorectal cancer for patients with congenital intestinal diseases. For patients with intestinal failure specifically, alcohol needs to be viewed as an additional sugar source. Bowel absorption capacity may be increased for this patient group, meaning that individuals require lower quantities of alcohol to feel the effects. While smoking and excessive alcohol consumption are discouraged from a medical perspective, those over the legal age have a personal choice. Clinicians should be encouraged to share information on how alcohol and smoking can affect patients with congenital anomalies, so that patients can make an informed choice.