Systematic review with meta‐analysis: the adverse effects of tobacco smoking on the natural history of Crohn's disease

To, Natalie; Gracie, David J.; Ford, Alexander C

doi:10.1111/apt.13511

Cited by 140 publications

(106 citation statements)

References 85 publications

(221 reference statements)

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“…In a recent meta-analysis, To et al ( 174 ) found in 33 studies a 56% higher risk of a fl are of disease activity and a twofold risk of fl are aft er surgery along with a need for fi rst surgery (OR 1.68; 95% CI, 1.33-2.12) and the need for second surgery (OR 2.17; CI, 1.63-2.89) in smokers.…”

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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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

View full text Add to dashboard Cite

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“…Guarantor of the article: Gilaad G. Kaplan 54% more likely to require a fi rst intestinal resection as compared with non-smokers ( 13 ). Patients who continue to smoke following the fi rst operation have an over twofold increased risk of experiencing clinical postoperative recurrence ( 14 ) and need for second intestinal resection ( 13 ).…”

Section: Conflict Of Interestmentioning

confidence: 99%

“…Patients who continue to smoke following the fi rst operation have an over twofold increased risk of experiencing clinical postoperative recurrence ( 14 ) and need for second intestinal resection ( 13 ).…”

Section: Conflict Of Interestmentioning

confidence: 99%

“…Th e relationship is predominantly among patients diagnosed with Crohn's disease in adulthood, whereas passive exposure to smoking in childhood is not associated with Crohn's disease ( 12 ). A recently published meta-analysis demonstrated that patients diagnosed with Crohn's disease who continue to smoke were 56% more likely to experience a fl are-up as compared with non-smokers ( 13 ( 25 ) conducted a cost-utility analysis, which demonstrated that smoking cessation programs prescribing varenicline or nicotine replacements in conjunction with counseling were cost eff ective. A budget impact assessment conservatively estimated that over a 5-year window the cost-savings of prescribing varenicline to patients with Crohn's disease would exceed $61 million in the US ( 25 ).…”

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confidence: 99%

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Editorial: Smoking Cessation for Crohn’s Disease: Clearing the Haze

Kaplan

2016

American Journal of Gastroenterology

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The TABACROHN Study Group conducted a multicenter prospective cohort study, demonstrating that smoking cessation improved the prognosis of Crohn's disease. Patients who continued to smoke were 50% more likely to relapse compared with non-smokers. Smoking cessation reduced the risk of fl aring, regardless of exposure to anti-tumor necrosis factor agents. Despite the evidence that smoking cessation is benefi cial, many patients do not quit smoking after their diagnosis of Crohn's disease. Lack of awareness, physical addiction, and social context of smoking inhibit smoking cessation. In spite of this, comprehensive smoking cessation programs have been shown to be effective and reduce costs.

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“…DEAR SIRS, We read with great interest the systematic review with meta-analysis by To et al 1 regarding the effects of smoking on disease course in Crohn's disease (CD). The authors analyzed 33 studies comparing CD patients, smokers vs. nonsmokers, and observed that smokers had increased odds of flare of disease activity (OR, 1.56), flare after surgery (OR, 1.97), need for first surgery (OR, 1.68) and need for second surgery (OR, 2.17).…”

mentioning

confidence: 99%