Inflammatory bowel disease and smoking. A review of epidemiology, pathophysiology, and therapeutic implications

Authors

  • Tanja Birrenbach MD,

    1. Department of Medicine II, (Gastroenterology/Hepatology/Infectious Diseases), Medical Faculty of Mannheim, University of Heidel-berg, Mannheim, Germany
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  • Ulrich Böcker MD

    Corresponding author
    1. Department of Medicine II, (Gastroenterology/Hepatology/Infectious Diseases), Medical Faculty of Mannheim, University of Heidel-berg, Mannheim, Germany
    • Department of Medicine II (Gastroenterology/Hepatology/Infectious Diseases), University of Heidelberg, Medical Faculty at Mannheim, Theodor-Kutzer-Ufer, D-68135 Mannheim, Germany
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Abstract

The relationship between smoking behavior and inflammatory bowel disease (IBD) is complex. While Crohn's disease (CD) is associated with smoking and smoking has detrimental effects on the clinical course of the disease, ulcerative colitis (UC) is largely a disease of nonsmokers and former smokers. Furthermore, cigarette smoking may even result in a beneficial influence on the course of ulcerative colitis. The potential mechanisms involved in this dual relationship include changes in humoral and cellular immunity, cytokine and eicosanoid levels, gut motility, permeability, and blood flow, colonic mucus, and oxygen free radicals. Nicotine is assumed to be the active moiety. The differential therapeutic consequences comprise the cessation of smoking in CD and, so far, clinical trials using nicotine in different forms of application for UC. In this article, we review the relationship between cigarette smoking and IBD, considering epidemiological, pathogenetic, and clinical aspects.

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