Extraintestinal Manifestations of Inflammatory Bowel Disease and the Influence of Smoking

Roberts, Henry L.; Shesh, N.; Pan, Jianmin; Rao, J. Michael; Keskey, Robert; Kanaan, Ziad; Short, Ethan P.; Mottern, Edward; Galandiuk, Susan

doi:10.1159/000363228

Cited by 38 publications

(37 citation statements)

References 15 publications

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“…The association between UC and PG was more protruding among non-smokers. This nding accords with the conclusions drawn from several observational studies suggesting that cigarette smoking does not confer risk for cutaneous manifestations in IBD (including both PG and erythema nodosum) [8,21,22]. In contrast, cigarette smoking was a signi cant predictor of PG in a cohort of patients with UC [23].…”

Section: Resultssupporting

confidence: 89%

Estimating the Risk of Ulcerative Colitis-Associated Pyoderma Gangrenosum: A Population-Based Case-Control Study

Kridin

Damiani²,

Ludwig

et al. 2020

Preprint

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BackgroundUlcerative colitis (UC) is a well-known underlying comorbidity in pyoderma gangrenosum (PG). However, the relative risk conferred by UC for the subsequent development of PG is yet to be explicated.ObjectiveTo estimate the magnitude of the association between UC and the subsequent occurrence of PG, thus enabling to assess the PG risk with UC.MethodsA population-based case-control study was conducted comparing PG patients (n = 302) with age-, sex- and ethnicity-matched control subjects (n = 1,497) regarding the presence of UC. Logistic regression models were utilized for univariate and multivariate analyses.ResultsThe prevalence of UC was greater in patients with PG than in control subjects (7.3% vs. 0.5%, respectively; P < 0.001). A 15-fold increase in the odds of PG with UC (OR, 14.62 95% CI, 6.45–33.18) was observed. This association retained its statistical significance following a sensitivity analysis excluding UC cases diagnosed up to 2 years prior to PG (OR, 9.88; 95% CI, 3.91–24.97), and after adjusting for confounding factors (adjusted OR, 10.78; 95% CI, 4.55–25.52). The median latency between the diagnosis of UC and the development of PG was 4.59 years. Patients with both PG and UC were younger and had a lower prevalence of smoking when compared to the remaining patients with PG.ConclusionsUC increases the odds of developing PG by 15-folds. Physicians managing patients with UC should be aware of this increased burden. Patients with UC may be advised to avoid additional precipitating factors of PG.

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Section: Resultssupporting

confidence: 89%

Estimating the Risk of Ulcerative Colitis-Associated Pyoderma Gangrenosum: A Population-Based Case-Control Study

Kridin

Damiani²,

Ludwig

et al. 2020

Preprint

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“…Prior case series have been divided on smoking's influence over extra‐intestinal manifestations overall in CD . Smoking correlated with an increase in ocular extra‐intestinal manifestations in UC but to our knowledge an association between smoking and arthritis alone has not been previously demonstrated. It is possible, given peripheral arthritis has been associated with increased degrees of intestinal inflammation, that this is a surrogate of increased disease activity in smokers of this cohort.…”

Section: Discussionmentioning

confidence: 78%

Smoking prevalence and its influence on disease course and surgery in Crohn's disease and ulcerative colitis

Lunney

Kariyawasam

Wang

et al. 2015

Aliment Pharmacol Ther

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Summary Background Smoking demonstrates divergent effects in Crohn's disease (CD) and ulcerative colitis (UC). Smoking frequency is greater in CD and deleterious to its disease course. Conversely, UC is primarily a disease of nonsmokers and ex‐smokers, with reports of disease amelioration in active smoking. Aim To determine the prevalence of smoking and its effects on disease progression and surgery in a well‐characterised cohort of inflammatory bowel diseases (IBD) patients. Methods Patients with smoking data of the Sydney IBD Cohort were included. Demographic, phenotypic, medical, surgical and hospitalisation data were analysed and reported on the basis of patient smoking status. Results 1203 IBD patients were identified comprising 626 CD and 557 UC with 6725 and 6672 patient‐years of follow‐up, respectively. CD patients were more likely to smoke than UC patients (19.2% vs. 10.2%, P < 0.001). A history of smoking in CD was associated with an increased proportional surgery rate (45.8% vs. 37.8%, P = 0.045), requirement for IBD‐related hospitalisation (P = 0.009) and incidence of peripheral arthritis (29.8% vs. 22.0%, P = 0.027). Current smokers with UC demonstrated reduced corticosteroid utilisation (24.1% vs. 37.5%, P = 0.045), yet no reduction in the rates of colectomy (3.4% vs. 6.6%, P = 0.34) or hospital admission (P = 0.25) relative to nonsmokers. Ex‐smokers with UC required proportionately greater immunosuppressive (36.2% vs. 26.3%, P = 0.041) and corticosteroid (43.7% vs. 34.5%, P = 0.078) therapies compared with current and never smokers. Conclusions This study confirms the detrimental effects of smoking in CD, yet failed to demonstrate substantial benefit from smoking in UC. These data should encourage all patients with IBD to quit smoking.

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“…Considering the risk factors for developing ocular manifestation in IBD, an association has been reported with female sex[ 17 , 23 , 31 ], and the presence of arthritis or arthralgia in CD patients[ 23 , 46 ]. A paradoxical positive association has been demonstrated between smoking and ocular manifestation in UC patients[ 49 ], because it is well known that smoking exerts a protective effect against both the development and progression of UC[ 50 , 51 ].…”

Section: Ocular Involvementmentioning

confidence: 99%

Ophthalmic manifestations in patients with inflammatory bowel disease: A review

Troncoso

Biancardi

Moraes

et al. 2017

WJG

108

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Clinical manifestations of inflammatory bowel disease (IBD) are not locally restricted to the gastrointestinal tract, and a significant portion of patients have involvement of other organs and systems. The visual system is one of the most frequently affected, mainly by inflammatory disorders such as episcleritis, uveitis and scleritis. A critical review of available literature concerning ocular involvement in IBD, as it appears in PubMed, was performed. Episcleritis, the most common ocular extraintestinal manifestation (EIM), seems to be more associated with IBD activity when compared with other ocular EIMs. In IBD patients, anterior uveitis has an insidious onset, it is longstanding and bilateral, and not related to the intestinal disease activity. Systemic steroids or immunosuppressants may be necessary in severe ocular inflammation cases, and control of the underlying bowel disease is important to prevent recurrence. Our review revealed that ocular involvement is more prevalent in Crohn’s disease than ulcerative colitis, in active IBD, mainly in the presence of other EIMs. The ophthalmic symptoms in IBD are mainly non-specific and their relevance may not be recognized by the clinician; most ophthalmic manifestations are treatable, and resolve without sequel upon prompt treatment. A collaborative clinical care team for management of IBD that includes ophthalmologists is central for improvement of quality care for these patients, and it is also cost-effective.

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Extraintestinal Manifestations of Inflammatory Bowel Disease and the Influence of Smoking

Cited by 38 publications

References 15 publications

Estimating the Risk of Ulcerative Colitis-Associated Pyoderma Gangrenosum: A Population-Based Case-Control Study

Estimating the Risk of Ulcerative Colitis-Associated Pyoderma Gangrenosum: A Population-Based Case-Control Study

Smoking prevalence and its influence on disease course and surgery in Crohn's disease and ulcerative colitis

Ophthalmic manifestations in patients with inflammatory bowel disease: A review

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