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

Abstract

Summary Background Ileal pouch‐anal anastomosis is a common surgical procedure in patients with an initial diagnosis of ulcerative colitis or indeterminate colitis. Tobacco smoking has been associated with protection from onset of ulcerative colitis. Smoking has been reported to be both a protective factor and a risk factor for the development of pouchitis. Aim To examine the influence of smoking on the risk of pouchitis. Methods We identified 15 studies evaluating smoking as a risk factor for developing pouchitis in ulcerative colitis or indeterminate colitis patients with a history of ileal pouch‐anal anastomosis in a systematic search performed from inception through May 4, 2020. A meta‐analysis was then performed using a random‐effects model to generate risk ratios (RR) and 95% confidence intervals (CI). Results A history of smoking compared with never smoking was not associated with an increased risk of developing pouchitis (RR = 0.94, 95% CI 0.76‐1.18, I2 = 73.7%). There was also no significant risk of pouchitis when comparing current smokers vs nonsmokers (RR = 0.93, 95% CI 0.70‐1.24, I2 = 78.5%) and former smokers vs nonsmokers (RR = 0.96, 95% CI 0.74‐1.23, I2 = 78.5%). Conclusions Smoking, past or present, is not associated with an increased risk for the development of pouchitis in patients with ulcerative colitis or indeterminate colitis.

Transmural Inflammation, Ileitis, and Granulomas at the Time of Proctocolectomy in Patients with Ulcerative Colitis Do Not Predict Future Development of Pouchitis

“…Our outcomes occurred in a single IBD center. Given that this was a retrospective study, we did not have accurate data regarding smoking or the presence of extraintestinal manifestations of UC at the time of colectomy, both of which have been evaluated as risk factors for pouchitis [29, 30]. We also did not evaluate the use of immunosuppressive or biologic therapies in the post-IPAA period, which could have influenced the development of pouch inflammation or other complications.…”

Einfluss des Rauchens auf den Gastrointestinaltrakt

“…Eine Metaanalyse von Kani et al. hat ergeben, dass Rauchen weder einen schädigenden noch einen schützenden Effekt auf die Entwicklung einer Pouchitis hat [ 38 ].…”

Medical treatment of pouchitis: a guide for the clinician

“… 104 A meta-analysis of 15 studies evaluating current, former, or never smokers found no association of smoking status with risk of development of pouchitis in patients with an IPAA. 16 Patients should be counseled that smoking is not recommended to prevent or treat pouchitis.…”

“…14 Increasingly, it is being recognized that the inflammation of pouchitis appears similar to ulcerative colitis. 15 Definitions of pouchitis vary by study, 16 including a combination of criteria based on symptoms, pouchoscopy findings, or histologic features. The most commonly use scoring system for pouchitis is the Pouchitis Disease Activity Index (PDAI).…”