Smoking Habit and Load Influence Age at Diagnosis and Disease Extent in Ulcerative Colitis

Aldhous, Marian C.; Drummond, Hazel E.; Anderson, Niall; Baneshi, Mohammad Reza; Smith, Linda A.; Arnott, Ian; Satsangi, Jack

doi:10.1111/j.1572-0241.2007.01065.x

Cited by 80 publications

(70 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Odes et al 35 also reported active smoking's protective effect against surgery in patients with UC. Aldhous et al, 4 however, observed no difference in time from diagnosis of UC to colectomy in those patients requiring surgery, between current smokers and nonsmokers; however, found that ex-smokers demonstrated a shorter time period between diagnosis and colectomy than nonsmokers. Boyko et al 34 found that exsmokers more frequently underwent colectomy than current smokers or nonsmokers; however no such difference was observed between current smoker and nonsmoker groups.…”

Section: 21mentioning

confidence: 95%

“…1,4,5,10,16,24 That is to say, heavier smokers are less likely to develop UC than lighter smokers 4 and current smokers who have a diagnosis of UC are more likely to have milder disease than ex-smokers and nonsmokers with UC. 1,4,5,24 Indeed, relatively heavy smokers have been observed to have less macroscopic and histological evidence of disease on colonoscopic examination, as compared with lighter smokers, ex-smokers and nonsmokers with UC. 4 Intermittent smokers have often been reported to experience symptomatic exacerbation during periods of nonsmoking and alleviation of symptoms on recommencement of smoking.…”

Section: 21mentioning

confidence: 99%

“…1,4,5,24 Indeed, relatively heavy smokers have been observed to have less macroscopic and histological evidence of disease on colonoscopic examination, as compared with lighter smokers, ex-smokers and nonsmokers with UC. 4 Intermittent smokers have often been reported to experience symptomatic exacerbation during periods of nonsmoking and alleviation of symptoms on recommencement of smoking. 2,5,6,15,20 The observation that heavier smokers who quit smoking are more susceptible to the rebound effect of developing UC, compared to lighter smokers, also corroborates the notion of a dose-dependent relationship.…”

Section: 21mentioning

confidence: 99%

“…[1][2][3][4] Paradoxically, UC appears to be predominantly a disease of ex-smokers and nonsmokers. 2, First noted by Samuelsson in 1976 25 and confirmed by Harries, Baird and Rhodes in 1982, 26 it was observed that there was a distinct lack of current smokers in a cohort of UC patients, compared with that of a group of matched control subjects.…”

Section: Introductionmentioning

confidence: 99%

“…Since then, numerous studies of the relationship between smoking and UC have confirmed this observation and demonstrated that smoking not only appears to protect against the development of UC, but in fact ameliorates the clinical course of the disease. [1][2][3][4][5][6]24 Subjectively, in a cohort of smokers with UC, over half-indicated smoking improved their disease and none felt smoking had a detrimental effect on their UC. 27 Similarly, in a group of ex-smokers with refractory UC, 14 out of 15 achieved prolonged clinical remission without steroids, following resumption of low-dose smoking.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Review article: ulcerative colitis, smoking and nicotine therapy

Lunney

Leong

2012

Aliment Pharmacol Ther

119

View full text Add to dashboard Cite

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.

show abstract

Section: 21mentioning

confidence: 95%

Section: 21mentioning

confidence: 99%

Section: 21mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Review article: ulcerative colitis, smoking and nicotine therapy

Lunney

Leong

2012

Aliment Pharmacol Ther

119

View full text Add to dashboard Cite

show abstract

Smoking Tobacco and Gastrointestinal Pathophysiology and Diseases

Asakura

2011

Cigarette Smoke Toxicity

View full text Add to dashboard Cite

Serologic and genetic markers do not aid in the determination of the clinical course and severity of patients with inflammatory bowel disease

Murphy

Kornbluth

2008

Inflammatory Bowel Diseases

View full text Add to dashboard Cite

A t present, despite the claims of promoters of new diagnostic approaches, the diagnoses of Crohn's disease (CD) and ulcerative colitis (UC) depend on a combination of clinical, laboratory, radiographic, endoscopic, and histological criteria. Once these diagnoses are established by traditional means, it would be desirable to predict the clinical course and prognosis for an individual patient. There have been substantial advances in the development and commercialization of a number of serologic and genetic markers in patients with IBD. These markers have incrementally advanced our understanding of the underlying aberrant immune responses in patients with IBD, particularly in CD. Nonetheless, they have yet to be prospectively shown to be sufficiently sensitive and specific to inform a given patient of their future. We remain humbled by our insufficient skills when it comes to gazing into the crystal ball of prognosis. In this article we describe the case for the importance of accurate disease phenotyping by our traditional and time-tested clinical means. In addition, we will address the potential pitfalls in predicting clinical course of disease based on the currently available serologic and genetic markers. Predictive Phenotypic Features of UCThe severity of UC is entirely based on its clinical phenotype. 1 Disease severity, which informs immediate treatment decisions, is categorized into mild, moderate, severe, and fulminant based on the assessment of simple, inexpensive, clinically relevant variables including stool number, rectal bleeding, fever, tachycardia, erythrocyte sedimentation rate, hematocrit, and endoscopic appearance. Predictive phenotypic information regarding UC has been available for many years and provides useful information to patients. A large case series (and therefore prone to referral bias) reported an analysis of 1116 patients with UC. Forty-six percent were found to have proctosigmoiditis, 17% left-sided colitis, and 37% pancolitis. 2 After a mean follow-up of more than 12 years, patients with pancolitis were at greatest risk for complications (colonic hemorrhage, toxic colitis, and surgery) and rates of taking medications and of being asymptomatic were 37% and 67%, respectively. A population-based study of 1161 Danish patients with UC reported that about half of patients were in remission at any time and 90% had an intermittent course. Disease activity in foregoing years indicated with 70%-80% probability that the disease would continue the following year. Most patients' lives were relatively little influenced by the disease and the probability of maintaining working capacity after 10 years was 92.8%. 3 If patients require treatment with corticosteroids, natural history studies can provide a guide as to the likely response. Analyzing population-based data from Olmsted County, Minnesota, researchers found that 34% of patients with UC were treated with corticosteroids and complete and partial remission rates were 58% and 26%, respectively. 4 Finally, it is known that smoking habit strongly ...

show abstract

Smoking Habit and Load Influence Age at Diagnosis and Disease Extent in Ulcerative Colitis

Abstract: Smoking habit influences the age at diagnosis and changes in disease extent in UC. Mechanisms are likely to be complex and require further investigation.

Cited by 80 publications

References 51 publications

Review article: ulcerative colitis, smoking and nicotine therapy

Review article: ulcerative colitis, smoking and nicotine therapy

Smoking Tobacco and Gastrointestinal Pathophysiology and Diseases

Serologic and genetic markers do not aid in the determination of the clinical course and severity of patients with inflammatory bowel disease

Contact Info

Product

Resources

About