IBD and smoking

Q: 34 years old male with an established diagnosis of ulcerative colitis is advised by his primary care physician to stop smoking. His ulcerative colitis may get? (select one)

A) better

B) worse

Answer: B

It may be a surprise to some that nicotine has a protective effect on the symptoms of ulcerative colitis. Unfortunately, patients with ulcerative colitis who also smoke, if quit smoking may get exacerbation of ulcerative colitis. Moreover, it may also be more challenging to treat. Symptoms may get better or resolve with the resumption of cigarette smoking. These patients are at a rock and a hard place.

Clinicians haven't yet resolved the mystery of why similar inflammatory bowel disease (IBD), i.e., Crohn's disease, may get exacerbated with smoking? Smoking increases the risk of strictures and fistulas in Crohn's disease.

#GI

#tobacco

References:

1. Mahid SS, Minor KS, Soto RE, et al. Smoking and inflammatory bowel disease: a meta-analysis. Mayo Clin Proc 2006; 81:1462.

2. Cosnes J, Beaugerie L, Carbonnel F, Gendre JP. Smoking cessation and the course of Crohn's disease: an intervention study. Gastroenterology 2001; 120:1093.

3. Boyko EJ, Perera DR, Koepsell TD, et al. Effects of cigarette smoking on the clinical course of ulcerative colitis. Scand J Gastroenterol 1988; 23:1147.

4. Beaugerie L, Massot N, Carbonnel F, et al. Impact of cessation of smoking on the course of ulcerative colitis. Am J Gastroenterol 2001; 96:2113.