Smoking influences the need for surgery in patients with the inflammatory bowel diseases: a systematic review and meta-analysis incorporating disease duration

Abstract

Background: Studies examining the association between smoking and the need for surgery in patients with Crohn's disease and ulcerative colitis have reached inconsistent conclusions. These studies often do not differentiate between patients undergoing early surgery and patients having surgery later in their disease course. Our study examined the association between smoking status and time to first bowel resection in patients with Crohn's disease and ulcerative colitis. Methods: We searched MEDLINE and EMBASE for studies (n = 12) reporting on the association between smoking status (current, former, and never) and surgery in IBD, and incorporated disease duration in the analysis. Hazard ratios (HR) with 95% confidence intervals (CI) were pooled across studies using random effects models. Results: Current smokers with Crohn's disease were at increased risk of intestinal resection compared to never smokers (HR 1.27, 95% CI 1.08 to 1.49); however, there was no difference in the need for surgery when comparing former and never smokers (HR 1.11, 95% CI 0.95 to 1.30). In patients with ulcerative colitis, there was no difference in the need for colectomy when comparing current smokers to never smokers (HR 0.98, 95% CI 0.67 to 1.44). Former smokers with ulcerative colitis were at increased risk of colectomy (HR 1.38, 95% CI 1.04 to 1.83) compared to never smokers. Conclusions: Current smokers with Crohn's disease are at increased risk of surgery, while former smokers with ulcerative colitis have increased risk of colectomy.

Smoking and Inflammatory Bowel Disease: A Comparison of China, India, and the USA

“…Many Western studies found current smoking to increase the risk and exacerbate the disease course of CD and to have the opposite impacts on UC [18, 21, 33]. However, we did not find statistically significant association between smoking and disease outcomes of CD and UC in the USA cases.…”

Comparison of time until elective intestinal resection regarding previous anti-tumor necrosis factor exposure: a Brazilian study on patients with Crohn's disease

“…A recent systematic review and meta-analysis conducted in Canada demonstrated that the time from diagnosis to surgery was shorter in smokers until a primary intestinal resection due to CD. 13 Our study did not observe such a link, probably owing to the reduced number of smokers in our sample (only 11 from the 123 patients analyzed), cultural trend in our country, and intense campaigns and public health efforts against smoking.…”

“… 11 12 Other factors, such as smoking, can also influence the timing of the need for a surgical resection. 13 …”

IBD2020 global forum: results of an international patient survey on quality of care

“…Poor communication included insufficient discussion about fundamental aspects of patients’ care within 3 months of diagnosis, including characteristics of IBD (24.4%), treatment goals (27.4%), or risks-benefits of treatment (40.5%). Half the patients with CD (50.6%) could not recall being told about the importance of avoiding smoking, despite well-established risks associated with smoking and exacerbation of CD [ 25 , 26 ]. For patients with established disease, communication deficits in the preceding 12 months included insufficient discussion of the goals of treatment (48.1%), general lifestyle issues (44.8%), medical treatment options (16.2%), or current symptoms (11.8%).…”