Late presentation of ulcerative colitis in ex-smokers

Abstract

Details of the smoking history were obtained from 288 patients with ulcerative colitis who were more than 15 years of age when colitis developed. Men who had previously smoked presented with colitis at a later age than lifelong non-smokers (mean age difference 15.2 years). The proportion of ex-smokers in this group of patients with colitis was more than twice that expected in the general population. The interval between cessation of smoking and subsequent onset of colitis in ex-smokers was found to be relatively short and in two-thirds of patients occurred within seven years. A tentative model to explain the association between smoking and subsequent colitis is proposed. We suggest that whilst current smokers may have a lower incidence of colitis, ex-smokers appear to be at increased risk of developing the disease. An alternative explanation is that smoking may act in a manner analogous to sulphasalazine.

Review article: ulcerative colitis, smoking and nicotine therapy

“…21,32 Interestingly, however, there does not appear to be any significant difference between ex-smokers and nonsmokers in disease extent, progression, or regression.…”

“…2, 5-8, 20, 21, 29, 31, 32 Ex-smokers have been observed to exhibit delayed onset of disease compared with lifetime nonsmokers. 8,21,32 In two studies, the mean age difference in men of disease onset between nonsmokers and those who previously smoked was found to be 15.2 32 and 16.1 years.…”

Current medical therapy for ulcerative colitis

“…The rationale to use this therapy is clear. Most UC patients are nonsmokers, and patients with a history of smoking usually acquire their disease within a few years after they have stopped smoking [20] . Among patients who continue to smoke, symptoms may improve, suggesting that smoking may have a beneficial effect.…”

“…The systemic absorption of mesalazine and its metabolite Ac-5-ASA were low. The new mesalazine enema represents an adequate alternative and a further technological improvement in the topical treatment of distal UC [20,21] . The choice between sulfasalazine and 5-aminosalicylate (5-ASA) drugs in the management of UC patients often depends on idiosyncrasies of drug tolerance and control of the disease in individual patients.…”

Medical Therapy of Inflammatory Bowel Disease

“…The rationale to use this therapy is clear. Most patients with ulcerative colitis are nonsmokers, and patients with a history of smoking usually acquire their disease within a few years after they have stopped smoking [42][43][44][45]. Among patients who continue to smoke, symptoms may improve, suggesting that smoking may have a beneficial effect [46,47].…”