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. 2016 Apr;10(4):455-61.
doi: 10.1093/ecco-jcc/jjv238. Epub 2015 Dec 30.

Smoking is Associated With Extra-intestinal Manifestations in Inflammatory Bowel Disease

M Severs  1 , S J H van Erp  2 , M E van der Valk  1 , M J J Mangen  3 , H H Fidder  1 , M van der Have  1 , A A van Bodegraven  4 , D J de Jong  5 , C J van der Woude  6 , M J L Romberg-Camps  7 , C H M Clemens  8 , J M Jansen  9 , P C van de Meeberg  10 , N Mahmmod  11 , C Y Ponsioen  12 , C Bolwerk  13 , J R Vermeijden  14 , M J Pierik  15 , P D Siersema  1 , M Leenders  16 , A E van der Meulen-de Jong  2 , G Dijkstra  17 , B Oldenburg  18 ; Dutch Initiative on Crohn and Colitis
Affiliations

Smoking is Associated With Extra-intestinal Manifestations in Inflammatory Bowel Disease

M Severs et al. J Crohns Colitis. 2016 Apr.

Abstract

Background and aims: Smoking affects the course of disease in patients with ulcerative colitis (UC) and Crohn's disease (CD). We aimed to study the association between smoking and extra-intestinal manifestations (EIMs) in inflammatory bowel disease (IBD).

Methods: We cross-sectionally explored the association between smoking and EIMs in IBD in three cohort studies: (1) the COIN study, designed to estimate healthcare expenditures in IBD; (2) the Groningen study, focused on cigarette smoke exposure and disease behaviour in IBD; and (3) the JOINT study, evaluating joint and back manifestations in IBD.

Results: In the COIN, Groningen and JOINT cohorts, 3030, 797 and 225 patients were enrolled, of whom 16, 24 and 23.5% were current smokers, respectively. Chronic skin disorders and joint manifestations were more prevalent in smoking IBD patients than in non-smokers (COIN, 39.1 vs 29.8%, p <0.01; Groningen, 41.7 vs 30.0%, p <0.01) in both CD and UC. In the JOINT cohort, smoking was more prevalent in IBD patients with joint manifestations than in those without (30.3 vs 13.0%, p <0.01). EIMs appeared to be more prevalent in high- than in low-exposure smokers (56.0 vs 37.1%, p = 0.10). After smoking cessation, the prevalence of EIMs in IBD patients rapidly decreased towards levels found in never smokers (lag time: COIN cohort, 1-2 years; Groningen cohort, within 1 year).

Conclusions: There is a robust dose-dependent association between active smoking and EIMs in both CD and UC patients. Smoking cessation was found to result in a rapid reduction of EIM prevalence to levels encountered in never smokers.

Keywords: Inflammatory bowel disease; extra-intestinal manifestations; smoking.

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Figures

Figure 1.
Figure 1.
Prevalence of extra-intestinal manifestations in smoking versus non-smoking inflammatory bowel disease patients.
See this image and copyright information in PMC

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