Crohn's disease and smoking: Is it ever too late to quit?

Lawrance, Ian C.; Murray, Kevin; Batman, B.; Gearry, Richard B.; Grafton, Rachel; Krishnaprasad, Krupa; Andrews, Jane M.; Prosser, Ruth; Bampton, Peter A.; Cooke, Sharon E.; Mahy, Gillian; Radford‐Smith, Graham; Croft, Anthony; Hanigan, Katherine

doi:10.1016/j.crohns.2013.05.007

Cited by 47 publications

(48 citation statements)

References 18 publications

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“…In our CD cohort, adalimumab was used in a greater proportion of nonsmokers than ever‐smokers ( P = 0.032). Non‐smokers more frequently received anti‐TNF agents as well in the study by Lawrance et al . Smokers may have been less likely to be treated with an anti‐TNF agent than nonsmokers due to a greater tendency for the need for surgery rather than medical therapy, due to progression towards complicated CD.…”

Section: Discussionsupporting

confidence: 91%

Smoking prevalence and its influence on disease course and surgery in Crohn's disease and ulcerative colitis

Lunney

Kariyawasam

Wang

et al. 2015

Aliment Pharmacol Ther

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Summary Background Smoking demonstrates divergent effects in Crohn's disease (CD) and ulcerative colitis (UC). Smoking frequency is greater in CD and deleterious to its disease course. Conversely, UC is primarily a disease of nonsmokers and ex‐smokers, with reports of disease amelioration in active smoking. Aim To determine the prevalence of smoking and its effects on disease progression and surgery in a well‐characterised cohort of inflammatory bowel diseases (IBD) patients. Methods Patients with smoking data of the Sydney IBD Cohort were included. Demographic, phenotypic, medical, surgical and hospitalisation data were analysed and reported on the basis of patient smoking status. Results 1203 IBD patients were identified comprising 626 CD and 557 UC with 6725 and 6672 patient‐years of follow‐up, respectively. CD patients were more likely to smoke than UC patients (19.2% vs. 10.2%, P < 0.001). A history of smoking in CD was associated with an increased proportional surgery rate (45.8% vs. 37.8%, P = 0.045), requirement for IBD‐related hospitalisation (P = 0.009) and incidence of peripheral arthritis (29.8% vs. 22.0%, P = 0.027). Current smokers with UC demonstrated reduced corticosteroid utilisation (24.1% vs. 37.5%, P = 0.045), yet no reduction in the rates of colectomy (3.4% vs. 6.6%, P = 0.34) or hospital admission (P = 0.25) relative to nonsmokers. Ex‐smokers with UC required proportionately greater immunosuppressive (36.2% vs. 26.3%, P = 0.041) and corticosteroid (43.7% vs. 34.5%, P = 0.078) therapies compared with current and never smokers. Conclusions This study confirms the detrimental effects of smoking in CD, yet failed to demonstrate substantial benefit from smoking in UC. These data should encourage all patients with IBD to quit smoking.

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Section: Discussionsupporting

confidence: 91%

Smoking prevalence and its influence on disease course and surgery in Crohn's disease and ulcerative colitis

Lunney

Kariyawasam

Wang

et al. 2015

Aliment Pharmacol Ther

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“…In a large cohort of 1,115 patients with CD who were prospectively followed across six cities in Australia, those who ceased smoking prior to diagnosis had a reduced likelihood of progressing to complicated disease behavior or need for intestinal surgery 93 . The TABACROHN study demonstrated that up to a third of patients were able to achieve complete smoking cessation within 18 months of an advice-based smoking cessation strategy 94 .…”

Section: Environmental Risk Factorsmentioning

confidence: 99%

Environmental Risk Factors for Inflammatory Bowel Diseases: A Review

2014

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Inflammatory bowel diseases (IBD) comprising Crohn’s disease (CD) and ulcerative colitis (UC) are chronic immunologically mediated diseases. The key mechanism underlying the pathogenesis of these diseases is a dysregulated immune response to commensal flora in a genetically susceptible host. Thus intestinal microbial dysbiosis, host genetics, and the external environment all play an important role in the development of incident disease and in determining subsequent disease behavior and outcomes. There are several well-defined or putative environmental risk factors including cigarette smoking, appendectomy, diet, stress and depression, vitamin D as well as hormonal influence. The effect of some of the risk factors appears to differ between CD and UC suggesting that despite shared genetic and immunologic mechanisms, distinct pathways of pathogenesis exist. There is a growing body of literature identifying risk factors for incident disease. There is less rigorous literature defining triggers of relapse, and few controlled clinical trials examining if modification of such risk factors results in an improvement in patient outcomes. This is an area of considerable patient, physician, and scientific interest, and there is an important unmet need for rigorous studies of the external environment in disease pathogenesis and subsequent course.

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“…Even survival may be affected if repeated surgery leads to intestinal failure (IF). The most important factors associated with risk of severe, disabling CD with IF include young age at diagnosis or first surgery, stricturing disease, family history of inflammatory bowel disease, smoking, and operative complications [1,2] . Notably, a recent population-based cohort study found a 2.2-fold decrease of surgery that occurred in parallel with increasing use of biologic agents [3] .…”

mentioning

confidence: 99%

Crohn's Disease and Intestinal Transplantation

Drastich

Oliverius

2017

Dig Dis

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Background: Most patients with Crohn's disease (CD) require one or more operations during their lifetime. Repeated resections and surgical complications may result in short gut in a subset of patients, typically those with extensive small bowel disease or a penetrating CD phenotype. The effects of short bowel syndrome (SBS) can range in seriousness from mild to life-threatening advanced intestinal failure. Worldwide, CD is the second leading indication for intestinal transplantation (ITx) in SBS, but the overall incidence of ITx is quite low. Key Messages: Currently, total parenteral nutrition (TPN) is the preferred treatment option for patients with SBS because of its superior survival outcome. However, TPN can fail from loss of venous access due to catheter-associated thromboses, recurrent catheter-related blood stream infections, or intestinal-failure-associated liver dysfunction. Three types of transplantations are available for CD patients - small bowel alone, liver plus small bowel and multivisceral, which includes other intra-abdominal organs. An abdominal wall transplant is required in case of abdominal wall defects or lack of free intra-abdominal space. The current 5-year survival rate of 54% following ITx of the isolated small bowel appears worse than that associated with TPN. However, outcomes are substantially improving because of surgical and technical advances and progress in medical therapy. On the other hand, ITx carries the risk of both complications (e.g., rejection, infections, and post transplant lymphoproliferative disorders) and adverse events associated with immunosuppression. CD recurrence has been reported in a few patients, but this primarily histologic recurrence might not be of great clinical importance. Conclusions: ITx has become a well-established treatment for those who fail on TPN and who have life-threatening complications. Fortunately, it concerns only a small proportion of CD patients, but it does offer reasonable survival and quality of life. Primary management of patients with small bowel failure should be provided by a center experienced in medical intestinal rehabilitation, nutrition, and transplantation of other solid organs.

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Crohn's disease and smoking: Is it ever too late to quit?

Abstract: Progression to B2/B3 disease and surgery is reduced by smoking cessation. All CD patients regardless of when they were diagnosed, or how many surgeries, should be strongly encouraged to cease smoking.

Cited by 47 publications

References 18 publications

Smoking prevalence and its influence on disease course and surgery in Crohn's disease and ulcerative colitis

Smoking prevalence and its influence on disease course and surgery in Crohn's disease and ulcerative colitis

Environmental Risk Factors for Inflammatory Bowel Diseases: A Review

Crohn's Disease and Intestinal Transplantation

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