Smoking and the Risk of Pouchitis in Ulcerative Colitis Patients With Ileal Pouch-Anal Anastomosis

Abstract

These results suggest that smoking cessation may increase the likelihood of developing pouchitis in tobacco users with UC and IPAA, but active smoking does not seem to be more effective in preventing this condition.

Systematic review with meta‐analysis: a history of smoking is not associated with a higher risk of pouchitis

“…Of the 15 manuscripts, 12 were retrospective studies, 4,[12][13][14][15][20][21][22][23][24][25][26] 2 were prospective 27,28 and 1 was case-control. 29 Twelve studies included ulcerative colitis patients only [12][13][14][15][20][21][22][23][24][25][26][27] ; three studies included both ulcerative colitis and indeterminate colitis patients. 4,28,29 A total of 2,276 IPAA patients were included in the systematic review and meta-analysis.…”

“…Eleven studies differentiated between current vs former smokers. 4,[12][13][14][15]20,22,23,[25][26][27] There was no significant increase in the [33][34][35] In a previous meta-analysis on tobacco smoking and risk of ulcerative colitis, the pooled odds ratio of developing ulcerative colitis was 0.41 (95% CI 0.34-0.48, P < 0.01) for current smokers compared with lifetime nonsmokers. 36 Although not recommended currently as a treatment strategy, there have also been numerous studies exploring the therapeutic use of tobacco or nicotine during flares of ulcerative colitis, in the form of resumption of low-dose smoking, nicotine enemas or transdermal nicotine patches.…”

“…22,25,29 Studies assessing smoking and pouchitis have been varied in their findings and statistical significance. Three studies have shown that smoking may have a protective benefit, 13,[26][27][28] one study has shown a harmful effect 15 and eleven studies have failed to show statistically significant differences in pouchitis rates between smokers and nonsmokers. 4,12,14,16,[20][21][22][23][24][25]29 Notably, all except two of these studies were retrospective and sample sizes varied widely, from 10 to 353 subjects.…”

“…Twelve studies differentiated between current smokers, former smokers and nonsmokers. 4,[12][13][14][15][20][21][22][23][25][26][27] There was no significant increase in the risk of pouchitis seen when comparing current smokers vs nonsmokers (RR = 0.93, 95% CI 0.70-1.24, I 2 = 78.5%) and former smokers vs nonsmokers (RR = 0.96, 95% CI 0.74-1.23, I 2 = 78.5%). Eleven studies differentiated between current vs former smokers.…”

“…11 However, smoking has been identified as both a protective factor and a risk factor for the development of pouchitis. [12][13][14][15][16] Given the known association between smoking and ulcerative colitis, and the histopathologic similarities between ulcerative colitis and pouchitis, it has been postulated that smoking may impact the development of pouchitis. 17 In this systematic review and meta-analysis, we examine the association of smoking with the development of pouchitis.…”