Does Smoking Influence Crohnʼs Disease in the Biologic Era? The TABACROHN Study

Nunes, Tiago; Etchevers, María Josefina; Merino, Olga; Gallego, Sonia; García–Sánchez, Valle; Marín-Jiménez, Ignacio; Menchén, Luís; Acosta, Manuel Barreiro‐de; Bastida, Guillermo; García, Sara Mallén; Gento, Elena; Ginard, Daniel; Gomollón, Fernando; Arroyo, Maite; Monfort, David; García‐Planella, Esther; Gonzalez, Benito; Loras, Carme; Agustı́, Carles; Figueroa, Carolina; Sans, Miquel

doi:10.1002/ibd.22959

Cited by 43 publications

(39 citation statements)

References 35 publications

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“…In addition, current smokers presented higher use of biologic drugs compared with nonsmokers. Tobacco exposure and a higher tobacco load were independent predictors of need for maintenance treatment and stenosing phenotype, respectively ( 173 ).…”

Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

403

421

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Recent data suggest that infl ammatory bowel disease (IBD) patients do not receive preventive services at the same rate as general medical patients. Patients with IBD often consider their gastroenterologist to be the primary provider of care. To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. Gastroenterologists need to explicitly inform the primary care provider of the unique needs of the IBD patient, especially those on immunomodulators and biologics or being considered for such therapy. In particular, documentation of up to date vaccinations are crucial as IBD patients are often treated with long-term immune-suppressive therapies and may be at increased risk for infections, many of which are preventable with vaccinations. Health maintenance issues addressed in this guideline include identifi cation, safety and appropriate timing of vaccinations, screening for osteoporosis, cervical cancer, melanoma and non-melanoma skin cancer as well as identifi cation of depression and anxiety and smoking cessation. To accomplish these health maintenance goals, coordination between the primary care provider, gastroenterology team and other specialists is necessary. of evidence, we entered data from the papers of highest evidence into the GRADE program (accessible at http://www.gradepro.org ). Th e recommendation statements from this guideline are shown in Table 1 . Summary statements, when listed, are designed to be descriptive in nature without associated evidence-based ratings. VACCINATIONSRecent data suggest that IBD patients do not receive preventive services at the same rate as general medical patients ( 2 ). Members of the gastroenterology team are oft en the only clinicians that a patient with IBD will see. As such, it is incumbent upon gastroenterologists to take a proactive role in the health care needs of their IBD patients ( 3-5 ). It is crucial to clarify with the patient the limits of the specialist's responsibilities and delegate routine health care issues to the primary care clinician. It is equally important to educate the primary care clinician to the unique health maintenance needs of the IBD patient, especially those on immunomodulators and biologic agents. Although it appears that both primary care clinicians and gastroenterologists are hesitant to take ownership of vaccinations ( 6-8 ), it is reasonable ( 9 ) that vaccination recommendations be the responsibility of the treating gastroenterologist, but the actual delivery/administration of these vaccines may be a shared responsibility ( 10-13 ). Communicating specifi c recommendations to the primary care team in a concise fashion are needed. Consider empowering the patient by giving written recommendations to bring to their primary care physician. Clinicians sharing an electronic medical record should use this platform to send recommendations to the referring clinician.Patients with IBD are oft en treated with long-term immunesuppressive therapies and may t...

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Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

403

421

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“…Third, we did not have information on smoking, which previously was linked to poor outcomes in CD. 11,26–29 However, considering that smoking generally is discouraged in patients using oral contraceptives, particularly the combination type, adjusting for smoking likely would have strengthened our observed associations. Fourth, our cohort consisted almost entirely of Scandinavian women, and therefore it is possible that our findings may not be generalizable to other races/ethnicities.…”

Section: Discussionmentioning

confidence: 85%

Association Between Long-term Oral Contraceptive Use and Risk of Crohn’s Disease Complications in a Nationwide Study

et al. 2016

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BACKGROUND & AIMS Use of exogenous hormones, in the form of oral contraceptives (OCs), has been linked consistently to risk of Crohn’s disease (CD). Nonetheless, it is not clear how OCs might contribute to the progression of CD. METHODS We conducted a prospective study of female patients with CD (age, 16–51 y), identified from the inpatient and outpatient care components of the Swedish National Patient Register from January 2002 through December 2013. Information on current OC use was obtained from the Prescribed Drug Register starting in July of 2005 and updated until December of 2013. Primary outcomes were defined as first CD-related surgery and first steroid prescription. We used Cox proportional hazard modeling with time-varying covariates to estimate multivariable-adjusted hazard ratios (MV-adjusted HRs). RESULTS We identified 482 incident cases of surgery among 4036 patients with CD, with a median follow-up period of 58 months. Compared with nonusers, the MV-adjusted HRs for surgery were 1.14 (95% confidence interval [CI], 0.80–1.63) for past users and 1.30 (95% CI, 0.89–1.92) for current users. The risk of surgery increased with longer duration of use (Ptrend = .036) and higher prescribed daily dose (Ptrend = .016). Specifically, for women with more than 3 years of OC use, the MV-adjusted HR for surgery was 1.68 (95% CI, 1.06–2.67). The association was confined to the combination type of OC. We estimated that for every 83 patients with CD receiving the combination type of oral contraceptives for at least 1 year, 1 extra surgery is required. The rate of steroid prescriptions did not appear to increase with past or current use of OCs, compared with patients who have not taken OCs (all Pcomparisons > .20). CONCLUSIONS In a nationwide analysis of patients in Sweden, long-term use of OCs, particularly the combination type, was associated with an increased risk of surgery among women with established CD. Clinicians carefully should evaluate and monitor contraceptive options among women with established CD.

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“…For example, two studies found no statistically significant association between smoking and the risk of CD among 173 CD cases and 208 controls recruited from the Crohn’s and Colitis Foundation of America [34] and among 327 CD and 779 controls in Denmark [35]. Two large (408 and 1170 CD cases) European studies suggested a lack of association between smoking and disease location, the development of stricturing or penetrating behaviors, and the need for surgery [36, 37]. Another European study reported that smoking did not increase the risk of surgery and the prevalence of penetrating or stricturing behaviors among CD patients who were treated with immunosuppressive therapy [38, 39].…”

Section: Discussionmentioning

confidence: 99%