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Background  Although cigarette smoking affects all biological systems of the human body including the gastrointestinal tract, there is a lack of evidence regarding its effect on the severity of diarrhoeal disease and whether a dose–response relationship exists. We therefore tested for the presence of specific causative pathogens for infectious diarrhoea, assessed the independent effect of smoking on its severity and tested whether any dose–response relationship existed while controlling for subjects’ age, sociodemographic characteristics and presence of causative pathogens in an urban setting in Bangladesh.    Methods  A total of 20,757 patients aged 15 years and above with diarrhoea were enrolled into the Diarrhoeal Disease Surveillance System, managed by the International Centre for Diarrhoeal Disease Research, Bangladesh, from 1993 to 2012. We collected data on individuals’ current daily consumption of cigarettes and bidis (traditional hand-rolled cigarettes) and conducted an ordered logistic regression to determine the effect of smoking on diarrhoeal disease severity and whether a dose–response relationship exists.    Results  We identified 19 % of patients with diarrhoea as smokers, of whom 52 % smoked 1–9 cigarettes per day. While 97 % of smokers were male, 41 % were aged 15–30 years of age. Smokers were found to have a significantly lower severity of diarrhoeal disease (OR: 0.92, 95 % CI: 0.85–0.99, p = 0.025) after adjusting for age, wealth quintile, illiteracy and the presence of specific causative pathogens ( Vibrio cholerae  and  Shigella ). We observed no dose–response relationship between the number of cigarettes smoked per day and disease severity when adjusting for the same covariates. Smokers were more frequently infected with  Shigella  (7 vs. 6 %, p < 0.001) and less often with  Vibrio cholerae  (22 vs. 26 %, p < 0.001) than their non-smoking counterparts.    Conclusions  The aetiology and severity of diarrhoeal disease differed between smokers and non-smokers in our sample. However, we found no dose–response relationship between disease severity and the number of cigarettes smoked per day.

Diarrhoea and smoking: an analysis of decades of observational data from Bangladesh