Smokers with active Crohnʼs disease have a clinically relevant dysbiosis of the gastrointestinal microbiota*

Benjamin, Jane; Hedin, Charlotte; Κουτσουμπασ, Ανδρεασ; Ng, Siew C; McCarthy, Neil E.; Prescott, Natalie J.; Pessoa-Lopes, Pedro; Mathew, Christopher G.; Sanderson, Jeremy; Hart, Ailsa; Kamm, Michael A.; Knight, Stella C.; Forbes, Alastair; Stagg, Andrew J.; Lindsay, James O.; Whelan, Kevin

doi:10.1002/ibd.21864

Cited by 196 publications

(155 citation statements)

References 47 publications

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“…The proportion of microbiota was not significantly different between age categories, sex or race, and was not affected by CD activity index, ileal resection, colonic involvement, C-reactive protein levels, current use of steroids or immunomodulators or disease duration. 75 As similar changes in intestinal microbiota were found in both non-IBD smokers as well as CD smokers, the dysbiosis appeared to be directly attributable to smoking, and therefore changes in the microbiota were unlikely to be simply secondary to the inflammation. Also, Bacteroides species has been previously shown to have proinflammatory effects.…”

Section: 21mentioning

confidence: 65%

“…2 Disruption of the gastrointestinal microbiota has been identified in smokers with active CD. 75 Measuring the percentage of bacteria against the total microbiota load, smokers with or without CD had significantly increased Bacteroides-Prevotella in their faecal samples compared to nonsmokers (mean 38.8% in smokers vs. 28.3% in nonsmokers, P < 0.001). This study utilised 16sRNA fluorescent in situ hybridisation to detect the bacteria of interest.…”

Section: 21mentioning

confidence: 96%

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Review article: ulcerative colitis, smoking and nicotine therapy

Lunney

Leong

2012

Aliment Pharmacol Ther

119

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SummaryBackgroundSmoking is the best‐characterised environmental association of ulcerative colitis (UC). Smoking has been observed to exert protective effects on both the development and progression of UC.AimsTo examine the association between UC and smoking, possible pathogenic mechanisms and the potential of nicotine as a therapeutic agent in the treatment of UC.MethodsA literature search was conducted through MEDLINE, using the MeSH search terms ‘ulcerative colitis’ and ‘smoking’ or ‘nicotine’. Relevant articles were identified through manual review. The reference lists of these articles were reviewed to include further appropriate articles.ResultsUlcerative colitis is less prevalent in smokers. Current smokers with a prior diagnosis of UC are more likely to exhibit milder disease than ex‐smokers and nonsmokers. There is conflicting evidence for smokers having reduced rates of hospitalisation, colectomy and need for oral corticosteroids and immunosuppressants to manage their disease. Multiple potential active mediators in smoke may be responsible for these clinical effects, including nicotine and carbon monoxide, but the precise mechanism remains unknown. Nicotine has demonstrated variable efficacy in the induction of remission in UC when compared to placebo and conventional medicines. Despite this, the high frequency of adverse events limits its clinical significance.ConclusionsNicotine's application as a therapeutic treatment in ulcerative colitis is limited. Presently, it may be an option considered only in selected cases of acute ulcerative colitis refractory to conventional treatment options. This review also questions whether nicotine is the active component of smoking that modifies risk and inflammation in ulcerative colitis.

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Section: 21mentioning

confidence: 65%

Section: 21mentioning

confidence: 96%

Review article: ulcerative colitis, smoking and nicotine therapy

Lunney

Leong

2012

Aliment Pharmacol Ther

119

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“…Th ere are several proposed biologic mechanisms as possible explanations for this association ranging from altered autophagy and consequent epithelial oxidative damage ( 181 ), genetics with altered IL23R SNPs ( 182 ), dysfunctional mononuclear cells ( 183 ), and altered bacterial microbiota profi les in smokers with CD ( 184 ).…”

Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

391

421

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Recent data suggest that infl ammatory bowel disease (IBD) patients do not receive preventive services at the same rate as general medical patients. Patients with IBD often consider their gastroenterologist to be the primary provider of care. To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. Gastroenterologists need to explicitly inform the primary care provider of the unique needs of the IBD patient, especially those on immunomodulators and biologics or being considered for such therapy. In particular, documentation of up to date vaccinations are crucial as IBD patients are often treated with long-term immune-suppressive therapies and may be at increased risk for infections, many of which are preventable with vaccinations. Health maintenance issues addressed in this guideline include identifi cation, safety and appropriate timing of vaccinations, screening for osteoporosis, cervical cancer, melanoma and non-melanoma skin cancer as well as identifi cation of depression and anxiety and smoking cessation. To accomplish these health maintenance goals, coordination between the primary care provider, gastroenterology team and other specialists is necessary. of evidence, we entered data from the papers of highest evidence into the GRADE program (accessible at http://www.gradepro.org ). Th e recommendation statements from this guideline are shown in Table 1 . Summary statements, when listed, are designed to be descriptive in nature without associated evidence-based ratings. VACCINATIONSRecent data suggest that IBD patients do not receive preventive services at the same rate as general medical patients ( 2 ). Members of the gastroenterology team are oft en the only clinicians that a patient with IBD will see. As such, it is incumbent upon gastroenterologists to take a proactive role in the health care needs of their IBD patients ( 3-5 ). It is crucial to clarify with the patient the limits of the specialist's responsibilities and delegate routine health care issues to the primary care clinician. It is equally important to educate the primary care clinician to the unique health maintenance needs of the IBD patient, especially those on immunomodulators and biologic agents. Although it appears that both primary care clinicians and gastroenterologists are hesitant to take ownership of vaccinations ( 6-8 ), it is reasonable ( 9 ) that vaccination recommendations be the responsibility of the treating gastroenterologist, but the actual delivery/administration of these vaccines may be a shared responsibility ( 10-13 ). Communicating specifi c recommendations to the primary care team in a concise fashion are needed. Consider empowering the patient by giving written recommendations to bring to their primary care physician. Clinicians sharing an electronic medical record should use this platform to send recommendations to the referring clinician.Patients with IBD are oft en treated with long-term immunesuppressive therapies and may t...

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“…Mutations in the TLR4 gene are associated with CD and UC [90], and TLR4 expression is upregulated in intestinal epithelium of IBD patients [91]. It has also been demostrated that mesalamine use is linked to a strong reduction in the abundance of Echerichia and Shigella [88,92]. Increased abundance of Fusobacteria, another phylum of adherent and invasive bacteria, has been associated with both UC and CD [93].…”

Section: Linked To CD [105]mentioning

confidence: 99%

The microbiota in inflammatory bowel disease

2015

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This review explores our current understanding of the complex interaction between environmental risk factors, genetic traits and the development of inflammatory bowel disease. The primacy of environmental risk factors is illustrated by the rapid increase in the incidence of the disease worldwide. We discuss how the gut microbiota is the proximate environmental risk factor for subsequent development of inflammatory bowel disease. The evolving fields of virome and mycobiome studies will further our understanding of the full potential of the gut microbiota in disease pathogenesis. Manipulating the gut microbiota is a promising therapeutic avenue.

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Smokers with active Crohnʼs disease have a clinically relevant dysbiosis of the gastrointestinal microbiota*

Abstract: Smokers have luminal microbiota that consist of significantly higher bacteroides. Investigation of whether this is one mechanism through which the negative effects of smoking on CD are mediated is warranted.

Cited by 196 publications

References 47 publications

Review article: ulcerative colitis, smoking and nicotine therapy

Review article: ulcerative colitis, smoking and nicotine therapy

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

The microbiota in inflammatory bowel disease

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