Gastroenterology

Gastroenterology

Volume 93, Issue 2, August 1987, Pages 316-321
Gastroenterology

Cigarette smoking and inflammatory bowel disease

https://doi.org/10.1016/0016-5085(87)91021-3Get rights and content

Abstract

In a case-control study 280 patients with inflammatory bowel disease and matched community controls taken from general practitioner lists were questioned about their smoking habits. Whether assessed by current or previous habits, patients with Crohn's disease were more likely to be or have been smokers than their matched controls and the association appeared strongest at disease onset (matched relative risk 4.1, p < 0.001). In contrast, patients with ulcerative colitis assessed in the same way were less likely to be smokers compared with their matched controls, with the association being equally strong at disease onset and currently (matched relative risk 0.17, p < 0.001). Among patients with ulcerative colitis who were exsmokers, 76% reported stopping smoking before disease onset compared with 13% of exsmokers with Crohn's disease. Contrary to earlier reports, there were only small and nonsignificant increases in the risk of Crohn's disease or ulcerative colitis in exsmokers. The strength, temporal precedence, and contrasting nature of the associations are evidence that smoking has an important etiologic role in inflammatory bowel disease. Smoking appears to be a factor in determining whether Crohn's disease or ulcerative colitis develops in predisposed individuals.

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    One study retrospectively examined case notes of a cohort of 506 patients with CD and found that in those patients who had B1 disease at diagnosis the odds ratio of developing B2/B3 disease was 2.02 in smokers vs non smokers (95% CI 1.30–3.16).13 There is marked heterogeneity in studies that have examined smoking status and disease location in CD with several studies suggesting a positive correlation with ileal disease,32,33 some showing a negative correlation with smoking and colonic disease33–35 and several showing no relationship at all.36–38 A systematic review examining this topic suggested that one possible explanation is the lack of uniformity in the definition of smoking status.39

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