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Effects of active and passive smoking on disease course of Crohn's disease and ulcerative colitis

Authors

  • Frans van der Heide MD,

    Corresponding author
    1. Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
    • Department of Gastroenterology and Hepatology, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
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  • Arie Dijkstra PhD,

    1. Department of Social and Organizational Psychology, University of Groningen, Groningen, The Netherlands
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  • Rinse K. Weersma MD, PhD,

    1. Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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  • Frans A. Albersnagel PhD,

    1. Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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  • Elise M.J. van der Logt PhD,

    1. Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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  • Klaas Nico Faber PhD,

    1. Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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  • Wim J. Sluiter MD, PhD,

    1. Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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  • Jan H. Kleibeuker MD, PhD,

    1. Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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  • Gerard Dijkstra MD, PhD

    1. Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Abstract

Background: Smoking is a remarkable risk factor for inflammatory bowel disease (IBD), aggravating Crohn's disease (CD) while having beneficial effects on ulcerative colitis (UC). We studied the effects of active and passive smoking in Dutch IBD patients.

Methods: A questionnaire focusing on cigarette smoke exposure was sent to 820 IBD patients. Returned questionnaires were incorporated into a retrospective chart review, containing details about disease behavior and received therapy.

Results: In all, 675 IBD patients (380 [56%] CD and 295 [44%] UC) responded. At diagnosis there were 52% smokers in CD, 41% in the general population, and 28% in UC. The number of present smokers in CD is lower than in the general population (26% versus 35%). No detrimental effects of active smoking on CD were observed, but passive smokers needed immunosuppressants and infliximab more frequently than nonpassive smokers. Active smoking had beneficial effects on UC, indicated by reduced rates of colectomy, primary sclerosing cholangitis, and backwash-ileitis in active smokers compared to never smokers, and higher daily cigarette dose correlated with less extensive colitis and a lower need for therapy. Furthermore, smoking cessation after diagnosis was detrimental for UC patients, indicated by increased needs for steroids and hospitalizations for patients that stopped smoking after compared to before the diagnosis.

Conclusions: Active smoking is a risk factor for CD, but does not affect the outcome; passive smoking is detrimental for the outcome of CD patients. In UC, active smoking shows dose-dependent beneficial effects. Our data suggest that passive smoking is a novel risk factor for CD.

(Inflamm Bowel Dis 2009)

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