Background: This study examines the effects of common environmental hazards such as tobacco, alcohol (facial flushing or not), areca nut, and Helicobacter pylori infection on different upper digestive diseases. Methods: This is a multi-hospital-based endoscopy-survey cross-sectional study. Study subjects were those who aged ≥ 20 years, received upper endoscopies, agreed to participate, and did not have diagnosed and treated for gastric-esophagus cancers or upper digestive tract operations in outpatient clinics at four hospitals from southwestern coast of Taiwan in a period of April 2008 and December 2013. Then, they were collected the necessary personal information and were checked the status of Helicobacter pylori (HP) infection. Adjusted odds ratio (aOR) and 95% confidence interval (CI) were presented. Results: 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. For facial flushing, it was the significant risk for reflux esophagitis and Barret's esophagus (aOR = 1.18 and 1.32, 95%CI = 1.07-1.31 and 1.06-1.65, respectively), but not the risk of ESCC. In addition, HP infection was consistently and significantly risk factors for gastrointestinal diseases, including peptic ulcer, gastric adenocarcinoma, and duodenitis. Conclusion: Besides the risk of of alcohol, tobacco, and areca nut for Barrett's esophagus and ESCC, peptic ulcer, and duodenitis, respectively, presence of facial flushing was the significant risk for reflux esophagitis and Barret's esophagus and HP infection was significantly risk factors for gastrointestinal diseases, including peptic ulcer, gastric adenocarcinoma, and duodenitis.
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