The Role of Smoking in Crohn’s Disease as Defined by Clinical Variables

Abstract

The development of Crohn's disease (CD) is related to an interaction of genetic and environmental factors, with tobacco smoking being one of the most commonly studied environmental factors. In 1998, the Vienna classification was created to define CD by using three accepted clinical variables: age at diagnosis, disease behavior, and disease location. In this qualitative systematic review, articles examining the relationship between smoking and CD, using variables outlined in the Vienna classification, were identified utilizing multiple health databases. Current smoking was found to be associated with late-onset CD (> or =40 years old) and current smokers were more likely to progress to stricturing or penetrating type CD than were nonsmoking patients. Conflicting evidence exists regarding the relationship between smoking with respect to CD disease location. The Vienna classification is an important tool in permitting comparisons and predicting clinical course among CD cases, especially when smoking status is taken into account.

Smoking in inflammatory bowel diseases: Good, bad or ugly?

“…A recent review [36] and previous data have demonstrated that smoking, when measured up to the time point of disease behavior classification, was associated more frequently with complicated disease, penetrating intestinal complications [34,37,38] , and greater likelihood to progress to complicated disease, as defined by development of strictures or fistulae [36] , and a higher relapse rate [2,39] . Of note, previous severity of the disease, as assessed from the therapeutics needs, was found to be similar in young patients who started smoking and in their matched controls [10] .…”

“…Effect of smoking and its cessation on disease location, behaviour, and disease progression in Crohn's disease Smoking is associated with disease location: most, but not all, studies report a higher prevalence of ileal disease and a lower prevalence of colonic involvement in smokers [34][35][36] . A recent review [36] and previous data have demonstrated that smoking, when measured up to the time point of disease behavior classification, was associated more frequently with complicated disease, penetrating intestinal complications [34,37,38] , and greater likelihood to progress to complicated disease, as defined by development of strictures or fistulae [36] , and a higher relapse rate [2,39] .…”

Diretrizes para cessação do tabagismo - 2008

“…Level of evidence Peptic ulcer (2,166,167) • Imbalance between protection and aggression factors ( acid and pepsinogen release in the mucosa,  biliary reflux and vasopressin release in the hypothalamus,  gastric mucus production, blood flow in the mucosa, surface-active phospholipids and prostaglandins E 2 protection) • Association in development, perpetuation, and recidivism Risk factor for the disease A Crohn's disease (168,169) • Increased disease susceptibility and severity • Lower treatment response • Recidivism after surgery • Increased mortality risk Risk factor and difficult disease control A Liver disease (170,172) • Association with primary biliary cirrhosis development • Association in hepatic fibrosis clinical evolution (action of systemic inflammatory mediators and oxidative stress in the liver fibrogenesis)…”

Prognostic Factors in Crohn’s Disease

“…Согласно данным метаанализа девяти исследова-ний, курение вдвое повышает риск развития БК [27]. Многофакторный анализ результатов исследо-вания, включившего 3000 пациентов с БК, показал, что у некурящих был меньший временной интер-вал активной болезни по сравнению с умеренными (1-10 сигарет в день) и заядлыми (более 10 сигарет в день) курильщиками (33% против 38 и 41 соответ-ственно; р<0,0001) [28].…”

“…Авторы системати-ческого обзора по данной теме предположили, что одним из возможных объяснений этому явля-ется отсутствие единообразия в определении ста-туса курения [39]. Они предложили использовать следующие термины: «курильщик в настоящее…”