Tobacco and IBD: relevance in the understanding of disease mechanisms and clinical practice

• Published in: Baillière's best practice & research. Clinical gastroenterology Vol. 18; no. 3; pp. 481 - 496
• Main Author: Cosnes, Jacques
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.06.2004; Elsevier Limited
• Subjects: addiction; Antidepressants; Cognition & reasoning; Colitis, Ulcerative - etiology; Colitis, Ulcerative - physiopathology; Colitis, Ulcerative - therapy; Confidence intervals; Crohn Disease - etiology; Crohn Disease - physiopathology; Crohn Disease - therapy; Crohn's disease; Family physicians; Health psychology; Humans; Inflammatory bowel disease; nicotine; Nitric oxide; smoking; Smoking - adverse effects; Smoking Cessation; Surgery; Tobacco; ulcerative colitis; nicotine; addiction; smoking; Crohn's disease; tobacco; ulcerative colitis; inflammatory bowel disease
• ISSN: 1521-6918; 1532-1916
• DOI: 10.1016/j.bpg.2003.12.003

Current smoking protects against ulcerative colitis and, after onset of the disease, improves its course, decreasing the need for colectomy. However, smoking increases the risk of developing Crohn's disease and worsens its course, increasing the need for steroids, immunosuppressants and reoperations. Smoking cessation aggravates ulcerative colitis and improves Crohn's disease. The effects of smoking are the sum of contradictory effects of various substances, including nicotine and carbon monoxide, and are modulated by gender, genetic background, disease location and activity, cigarette dose and nicotine concentration. Smokers with ulcerative colitis should not be discouraged from stopping smoking but encouraged to stop, to reduce their risk of cardiopulmonary tobacco-related diseases. In Crohn's disease, smoking cessation has become a major therapeutic goal, particularly in young women and in patients with ileal involvement. A large amount of supportive information, use of nicotine-replacement therapies and antidepressants, and individual counselling might aid the patient in quitting.