We thank Drs Shiraki and Yamamoto for their letter[1] about our article.[2] Fibrotic intestinal strictures remain a challenging complication in Crohn's disease (CD), as there is currently no effective drug available, either to prevent or to treat bowel strictures. The treatment of active inflammation does not always prevent stricture formation, and we agree with the comments by Drs Shiraki and Yamamoto on the need for prospective trials on the optimal medical treatment to prevent intestinal strictures.

Smoking is common in patients with CD. Consistent with earlier reports, our data confirm and underscore that smoking has a deleterious effect on the clinical course of CD. It is well-documented that smokers have, in addition to an increased risk of developing CD, a more aggressive disease course with increased complication frequency, need for steroids, immunomodulators and re-operations, and also an increased risk of loss of response to antitumour necrosis factor therapies.

Our data now confirm an increased risk of recurrence of stricture after endoscopic dilation. Smoking cessation unequivocally improves the course of CD.[3] In a controlled trial, Cosnes et al. showed that ex-smokers had a 65% lower risk of disease flare-ups than patients who continued smoking.[4] Hence, smoking cessation is a very important goal in the management of CD and should be a primary therapeutic aim in smokers with the disease. In addition to positive effects on bowel disease, it also yields additional positive health effects on cardiovascular and pulmonary morbidity.


  1. Top of page
  2. Acknowledgement
  3. References

The authors’ declarations of personal and financial interests are unchanged from those in the original article.2


  1. Top of page
  2. Acknowledgement
  3. References
  • 1
    Shiraki M, Yamamoto T. Letter: the impact of smoking on clinical outcomes after endoscopic dilatation in Crohn's disease. Aliment Pharmacol Ther 2013; 37: 500.
  • 2
    Gustavsson A, Magnuson A, Blomberg B, Andersson M, Halfvarson J, Tysk C. Smoking is a risk factor for recurrence of intestinal stricture after endoscopic dilation in Crohn's disease. Aliment Pharmacol Ther 2013; 37: 4307.
  • 3
    Johnson GJ, Cosnes J, Mansfield JC. Review article: smoking cessation as primary therapy to modify the course of Crohn's disease. Aliment Pharmacol Ther 2005; 21: 92131.
  • 4
    Cosnes J, Beaugerie L, Carbonnel F, Gendre JP. Smoking cessation and the course of Crohn's disease: an intervention study. Gastroenterology 2001; 120: 10939.