Smoking does influence disease behaviour and impacts the need for therapy in Crohn′s disease in the biologic era

Nunes, Tiago; Etchevers, María Josefina; Domènech, Eugeni; García–Sánchez, Valle; Ber, Yolanda; Peñalva, Mireia; Merino, Olga; Nos, Pilar; García‐Planella, Esther; Casbas, Ana Gutiérrez; Esteve, María; Taxonera, Carlos; Montoro, Miguel; Gisbert, Javier P.; Arranz, María Dolores Martín; García-Sepulcre, M F; Acosta, Manuel Barreiro‐de; Beltrán, Belén; Suárez, N Alcaide; Gismera, C. Saro; Cabriada, José Luis; Cañas-Ventura, A.; Gomollón, Fernando; Panés, Julián

doi:10.1111/apt.12440

Cited by 77 publications

(56 citation statements)

References 45 publications

(128 reference statements)

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“…teristics, disease complications, therapeutic interventions, and smoking status demonstrated that in the time-dependent multivariate analysis, smokers were found to have a signifi cantly decreased survival free of stricturing disease (HR 1.5, 1.18-1.90) or perianal complications (HR 1.50; 95% CI, 1.01-1.46), and had a higher risk for requiring thiopurine therapy (HR 1.20; 95% CI, 1.05-1.30) ( 172 ).…”

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

View full text Add to dashboard Cite

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“…Previous studies have shown that smoking is both a risk factor for relapse of CD in general and for surgical recurrence in particular [14][15][16][17] . A recent multicenter prospective cohort study showed that despite the widespread use of immunosuppressants and anti-TNF antibodies, smokers with CD have a more severe disease course, including greater requirements for treatment, than non-smokers 18) . Furthermore, a retrospective study conducted to evaluate the effects of smoking at diagnosis on the clinical outcomes after endoscopic dilation found that smoking doubles the risk of recurrent stricture formation requiring further intestinal resection or strictureplasty.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for recurrence of Crohn's disease requiring surgery in patients receiving post-operative anti-tumor necrosis factor maintenance therapy

Araki

Okita

Kondo

et al. 2017

J Anus Rectum Colon

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Abstract:Objectives: Anti-tumor necrosis factor (TNF) antibodies have shown efficacy in the prevention of recurrence of Crohn's disease after intestinal resection. However, some patients develop surgical recurrence despite this therapy. We aimed to evaluate the risk factors for recurrence of Crohn's disease requiring surgery while receiving post-operative anti-TNF therapy. Methods: We performed a retrospective evaluation of 164 patients who had received post-operative anti-TNF maintenance therapy between 2002 and 2016. We classified Crohn's disease-related re-operation as surgical recurrence and analyzed its risk factors using the Cox proportional hazard model. Results: Of the 164 participants, 128 had received infliximab and 36 had received adalimumab maintenance therapy. We obtained follow-up data over a mean of 60.2 months. The proportion of patients with surgical recurrence at 5 years was 14.9%. The only independent risk factor for surgical recurrence, which we identified was post-operative smoking habit (odds ratio, 5.03; 95% CI, 1.14-12.8; P=0.033). Conclusions: Post-operative smoking may be a significant risk factor for post-operative surgical recurrence of Crohn's disease while receiving anti-TNF maintenance therapy.

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“…Недавно опубликованные результаты когорт-ного исследования, куда вошли 3224 пациента с БК, свидетельствуют о том, что у курильщиков реже наблюдается БК толстой кишки, чем у неку-рящих (7,9% против 10,9; p<0,05), но более вероят-на перианальная БК (29,5% против 26,2; p<0,05) [30]. Данные этого исследования также показали, что у курильщиков чаще, чем у некурящих боль-ных БК, встречается стриктурирующая форма бо-лезни (22,5 и 19,3% соответственно, p<0,05).…”

Section: курение и прогноз болезни кронаunclassified

“…В некоторых исследованиях, в ходе которых изучали зависимость локализации БК от курения, была показана положительная корреляция куре-ния с локализацией болезни в подвздошной киш-ке [33,34], в других была продемонстрирована от-рицательная корреляция курения и БК толстой кишки [30,34,35], а ряд исследований вообще не показал никакой связи между курением и локали-зацией заболевания [36,37,38]. Авторы системати-ческого обзора по данной теме предположили, что одним из возможных объяснений этому явля-ется отсутствие единообразия в определении ста-туса курения [39].…”

Section: курение и прогноз болезни кронаunclassified

Prognostic Factors in Crohn’s Disease

Щукина¹

2016

Alʹm. klin. med.

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ВВЕДЕНИЕБолезнь Крона (БК) -многофакторное гетероген-ное заболевание с прогрессирующим течением, ха-рактеризующееся хроническим воспалением желу-дочно-кишечного тракта (ЖКТ) [1]. За десятилетний период наблюдения стриктурирующие или пене-трирующие осложнения развиваются у каждого второго пациента с БК, а частота рецидивирования достигает 90% [2].С появлением терапии, способной приостано-вить прогрессирование БК, оценка прогноза на ран-ней стадии приобретает большое значение для раз-работки плана лечения с учетом степени тяжести заболевания [3,4,5,6,7,8]. В проведенных исследо-ваниях предложено множество определений небла-гоприятного (прогрессирующего) или тяжелого (ин-валидизирующего, осложненного) течения БК, сформулированных на основании особенностей раз-вития болезни в процессе определенного периода наблюдения. При этом оценивалось изменение фе-нотипа БК, то есть переход воспалительной формы заболевания в стриктурирующую или пенетрирую-щую форму с развитием соответствующих этим фор-мам осложнений, которые могут способствовать не-обратимому повреждению ЖКТ. Определялась также потребность в госпитализации, в хирургиче-ском лечении, учитывались отсутствие ответа на те-рапию, непрерывное или часто рецидивирующее течение, наличие тяжелых внекишечных проявле-ний, развитие стероидозависимости или стероидо-резистентности, необходимость раннего назначения стероидов и иммуносупрессоров, низкое качество жизни и др. ГЕНДЕРНЫЕ РАЗЛИЧИЯ И ПРОГНОЗ БОЛЕЗНИ КРОНАВ нескольких источниках литературы содержатся данные, свидетельствующие о наличии связи меж-ду гендерными различиями и исходами БК. N. Gupta и соавт. показали повышенный риск хи-рургических вмешательств у больных БК женского пола в педиатрической практике [9], в то время как в двух других исследованиях фактором риска хи-рургического лечения [10,11] PROGNOSTIC FACTORS IN CROHN'S DISEASE Shchukina O.B.North-Western State Medical University named after I. I. Mechnikov; 41 Kirochnaya ul., Saint-Petersburg, 191015, Russian Federation The paper contains a review of the literature data concerning the demographic, clinical, laboratory, genetic, immunohistochemical, endoscopic, and imaging features with a potential role of prognostic factors for clinical management of patients with Crohn's disease.

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Smoking does influence disease behaviour and impacts the need for therapy in Crohn′s disease in the biologic era

Abstract: SUMMARY Background

Cited by 77 publications

References 45 publications

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Risk factors for recurrence of Crohn's disease requiring surgery in patients receiving post-operative anti-tumor necrosis factor maintenance therapy

Prognostic Factors in Crohn’s Disease

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