Crohn’s Disease Relapses Strongly Tied to Tobacco Smoking

Crohn’s Disease Relapses Strongly Tied to Tobacco Smoking

Disease relapses in patients with Crohn’s disease and smoking appear to be strongly linked, a study titled “Impact of Smoking Cessation on the Clinical Course of Crohn’s Disease Under Current Therapeutic Algorithms: A Multicenter Prospective Study” reported. The study was published in The American Journal of Gastroenterology.

According to the Crohn’s and Colitis Foundation of America, approximately 1.6 million Americans suffer from inflammatory bowel disease (IBD), with Crohn’s disease (CD) being one main type of IBD. Tobacco smoking is the only environmental factor repeatedly linked to the development of CD, but only a handful of prospective studies have actually investigated the link between tobacco smoking and an increased frequency of clinical relapses in CD patients.

“The present study is indeed the second trial to prospectively assess the effect of smoking cessation on CD relapse and the first study to do so in the biologic era,” the researchers wrote, according to a news release.

In this multicenter prospective cohort study, a total of 573 CD patients were analyzed. The patients were in clinical remission with diverse smoking habits, and were all encouraged to quit smoking. The team examined the impact of smoking in clinical relapses and the advantages of quitting.

Patients were divided into four categories: 1) nonsmokers (n = 190), 2) former smokers (n = 160), 3) continuing smokers (n = 148), and 4), and patients who had just ceased smoking (n = 75). The changes in disease manifestation were evaluated and compared in an average follow-up time of 3.25 years.

Results from the multivariate analysis revealed that smoking is an independent predictor for relapses. Compared to nonsmokers, continuing smokers displayed earlier relapse, as well as a higher relapse incidence. Interestingly, former smokers and patients who ceased smoking had a relapse incident rate similar to nonsmokers. Patients who continued smoking also had double hospitalization incidents, and more a frequent need of steroid therapy compared to nonsmoking patients.

Researchers concluded that greater efforts to stop smoking in this patient population are needed.

“Currently, CD patients are still unaware of the risk related to their smoking habit. Even when the awareness is higher, very few smokers with CD are properly offered smoking cessation therapy,” the research team wrote. “Importantly, with no education and in the absence of smoking cessation strategies, very few CD patients quit spontaneously. Recent prospective studies have demonstrated that high smoking cessation rates (ranging from 12% to 37% at 1 year) are possible, and these patients should be effectively informed of the risk and offered educational and therapeutic support to quit or decrease their tobacco consumption.”