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Is Smoking Good For Ulcerative Colitis

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Nicotine And Ulcerative Colitis

DDW 2009 Poster Session – Patterns of Smoking…in Ulcerative Colitis

Ulcerative colitis is largely referred to as a disease of non-smokers. Former smokers are at the highest risk for developing ulcerative colitis, while current smokers have the least risk. This tendency indicates that smoking cigarettes may prevent the onset of ulcerative colitis.

Researchers have discovered that it is the nicotine in tobacco cigarettes that have a positive influence on symptoms of ulcerative colitis. Nicotine is a naturally occurring substance in tobacco that has a complex effect on many organs and systems in the body. Nicotine is also highly addictive, and many people who smoke cigarettes have difficulty quitting despite serious health risks.

It is theorized that the nicotine in cigarettes affects the smooth muscle inside the colon. This effect may alter gut motility .

Whole Spices And Herbs

Spices are good but not the whole ones. Do not add whole spices to your food because they will not get digested properly and can scrape the highly sensitive large intestinal walls. If you want to add flavor and aroma to your food, you can chop or grind the herbs and spices and use them. You can also put the spices in a muslin cloth and place it in your food to transfer the aroma.

Why Might Smoking Have A Protective Effect On Uc

The key is probably the nicotine in cigarette smoke. According to Crohns and Colitis UK, nicotine may suppress your immune system, decrease the inflammation of ulcerative colitis, and boost production of the mucus in the colon that acts as a protective barrier. Also, nitric oxide, a chemical released by nicotine, may help calm intestinal spasms that trigger the urge to have a bowel movement by reducing muscle activity in the colon.

All this is not to suggest that, if youre a smoker, you should forget about quitting in a bid to stave off ulcerative colitis. And if you dont smoke, it goes without saying that you should not consider taking it up. I advise all my patients to quit smoking because of its multitude of adverse effects on the body, says Matilda Hagan, MD, an inflammatory bowel disease specialist and co-medical director at the Center for Inflammatory Bowel and Colorectal Diseases at Mercy Medical Center in Baltimore. She notes that there are effective treatments, including drugs and other therapies, that address ulcerative colitis. Its true that those medications can have side effects, but the negative effect of smoking long-term outweighs any negative effects of UC medications.

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How Does Smoking Affect Ulcerative Colitis

Smokers and ex-smokers are less likely to suffer from ulcerative colitis. But that doesnt mean you should light up a cigarette.

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You never hear positive things about smoking, for obvious reasons: It dramatically increases your risk of lung cancer and other forms of cancer. Smoking is linked to 30 percent of all deaths from cancer in the United States, and 80 percent of lung cancer deaths. Its also a major contributor to heart disease. The list of negatives is overwhelmingly long, and the research is solid.

But theres one tiny check in the pro column for smoking: Cigarette smoking may have a protective effect on ulcerative colitis .

A review published in June 2020 in The American Journal of Gastroenterology noted that smokers were no more likely to experience severe ulcerative colitis flares. And, in some studies, smokers were less likely to need a colectomy than nonsmokers. An earlier study in The American Journal of Gastroenterology found that the heaviest smokers were the least likely to develop UC.

Influence Of Smoking On Disease Course

Ulcerative Colitis and Smoking: Things You Need to Know

Active tobacco smoking has a protective effect on the severity of UC the disease course is more benign in smokers than in non-smokers. Flare-up, hospitalization rates, the need for oral steroids and, more importantly, colectomy rate are reported to be lower in smokers compared with non-smokers, though this has not been observed in all studies.

The link between smoking and colectomy in UC patients is controversial. In a retrospective analysis of a large series of UC patients, current smoking was found to decrease the 10-year cumulative colectomy risk from 0.42 to 0.32. A subsequent meta-analysis with a total of 1489 UC patients found the risk for colectomy to be lower in current smokers compared with non-smokers.

In agreement with these results, a population-based cohort study performed in Europe with 771 UC patients prospectively included and followed for 10 years revealed a lower relapse rate in smokers compared with non-smokers. Another similar study carried out in the Netherlands by van der Heide et al with 295 UC patients identified smoking after diagnosis as a protective factor for colectomy , whereas pancolitis at diagnosis was a risk factor.

As well as the study by Beaugerie et al, Boyko et al reported a lower hospitalization rate in patients who were smoking at the onset of UC, but could not identify a difference in the colectomy rate between smokers and non-smokers.

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Alcohol And Colitis Medications

Alcohol may also worsen ulcerative colitis indirectly by interfering with the medications used to treat UC, especially Flagyl or other antibiotics.

Consult with your gastroenterologist or health care team on the safety of alcohol use with your medications to prevent potential harmful reactions and worsening of symptoms.

Risk Of Developing Uc

It is now fully accepted that UC predominantly affects non-smokers and former smokers, and that smoking exerts a universal protective effect against developing UC.

The influence of smoking in genetically predisposed IBD patients has been analyzed in family studies. It is well known that there is high concordance within a family between smoking habits and the IBD phenotype, with UC developing in non-smokers and CD in smokers. Thus, some of the apparent protection that smoking exerts on sporadic UC may be due not only to a therapeutic effect of tobacco usage, but rather that in some instances, it is CD rather than UC which develops as a result of the influence of smoking on the pathogenic processes. Bridger et al examined 89 sibling pairs with CD or UC discordant for both smoking and IBD phenotype to investigate whether smoking determines the type of IBD that develops in individuals with very similar genetic susceptibility. Of 89 sibling pairs discordant for smoking at diagnosis, 23 were also discordant for disease type. In 21 of these, CD occurred in the smoker and UC in the non-smoker, suggesting that tobacco consumption may act on the IBD genetic predisposition to shift the phenotype from UC towards CD. This role of smoking habits on the IBD phenotype has been confirmed in twins. Among 103 pairs , the frequency of smokers was lower among twins with UC. Furthermore, smoking habits were found to be of significance for discordance of disease.

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Nicotine Alleviates Ulcerative Colitis

One of the earliest noted effects of nicotine on a peripheral tissue was in inflammation of the intestine. Early reports mentioned patients with ulcerative colitis who upon cessation of smoking experienced more severe disease progression, which was ameliorated by returning to smoking . In contrast, patients with Crohn’s disease experienced severe disease when smoking, requiring the immediate cessation of any tobacco product use . Crohn’s disease is a chronic inflammatory disease, which might affect any part of the GI tract, causing a wide range of complications including ulceration, fibrostenosis, and fistula development resulting in symptoms like abdominal pain, fever, diarrhea, and weight loss during episodes with flare-ups. Smoking also worsens the course of Crohn’s disease by increasing the risk of developing fistulas and strictures as well as accelerating the need for surgery, probably due to an increased influx of neutrophils into the intestinal mucosa . These detrimental effects of smoking in Crohn’s disease could also be related to the nicotine-induced suppression of antimicrobial activity and immune responses by macrophages , which might further compound any deficiency in the host response to luminal bacteria.

If I Cant Stop Smoking Should I Try To Smoke Less

Nicotine To Treat Colitis?

Tools such as nicotine patches or nicotine-replacement therapy may help you quit smoking. If you cant stop smoking completely, even reducing the amount can have a positive effect on your symptoms. Several studies have found that heavy smokers have a higher risk of worse symptoms than light smokers do.

Helping people with Crohns quit smoking can be just as important as medication and treatments for the condition itself, many health professionals believe. If you are a smoker with Crohns disease, consider reaching out to your health care provider for encouragement and assistance to quit smoking.

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The Benefits Don’t Outweigh Smoking’s Risks

Some studies have shown that resuming smoking at a low level can relieve symptoms in people with UC for whom traditional treatments don’t work. However, the results are controversial. Another review of all the medical literature looked at many types of nicotine therapyincluding cigarettes, patches, gum, and enemasand found that none was effective for people with UC.

Keep in mind that smoking causes a wide range of harmful conditions. This includes other gastrointestinal conditions, such as Crohn’s disease, , gallstones, and ulcers. Work with your doctor to find the treatment plan that best relieves your symptoms without increasing your risk for other problems. Components of your plan may include dietary changes, medications, and surgery.

Smoking Increases Risk Of Complications In Crohns

Continued smoking is also associated with an increased incidence of complications in people with Crohns disease, some of which may require surgery. Studies show that current smokers are at an increased risk of developing complications such as strictures or fistulas . Both of these problems usually require surgery to correct.

One MyCrohnsAndColitisTeam member said, The one thing my doctors were certain of was that smoking made Crohn’s worse. I have found that to be very true.

In fact, people with Crohns who smoke are generally more likely to require surgery to address complications. They are also twice as likely to develop a disease recurrence after surgery, and they are more likely to require follow-up surgeries to address more problems that develop.

Other complications smokers with Crohns face include a higher risk of flare-ups, decreased blood flow in the gut, and inflammation that affects a larger portion of their gastrointestinal tract . Smokers are also more likely to have other health problems, such as osteoporosis, arthritis, skin disorders, or eye disorders. Women who smoke are more likely to develop worse symptoms or complications than are men who smoke.

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Ulcerative Colitis And Smoking

In those with ulcerative colitis, smoking has different outcomes. Non-smokers are at a greater risk of developing it compared to current smokers.1,5 In addition, heavier smokers are less likely to develop ulcerative colitis than lighter smokers.3,6 Current smokers were less likely to have required long-term corticosteroid therapy than non-smokers.5 Researchers suspect that this phenomenon may be due to the release of a protective factor in smokers with a genetic susceptibility to ulcerative colitis.3

Smokers were as likely to have undergone colectomy as people who never smoked and ex-smokers.5 Rates of hospitalization do not significantly differ for smokers and non-smokers.5 However, smoking correlates with an increase in ocular problems.7

Pathogenic Mechanisms Of Smoking On Uc Patients

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The exact mechanisms of action of nicotine and smoking in UC patients is not well known . Tobacco smoke contains hundreds of different substances including nicotine, free radicals and carbon monoxide. It is suspected that the main metabolite responsible for the impact on the course of UC is nicotine, however there is no absolute proof of nicotine being the sole active moiety. In consequence, probably the mechanisms are diverse and considering that the pathogenesis of UC is only partially understood, any dissertation on their possible mechanisms can only be hypothetical.

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Nicotine Patch May Offer Some Benefit To Those With Ulcerative Colitis

May 14, 2010

Dear Mayo Clinic:

When I quit smoking cigarettes four years ago, I discovered I have ulcerative colitis. After a few years of only moderate success treating it with medication, I started wearing a nicotine patch. My improvement was profound. Have there been any recent studies on this correlation? What information is available about long-term use of nicotine patches?


Research has shown an association between cigarette smoking and ulcerative colitis. Studies have found that smoking seems to provide short-term relief from ulcerative colitis symptoms. Based on those findings, doctors may recommend nicotine patches for some people to rein in ulcerative colitis flare-ups. But for long-term symptom control, this treatment doesn’t appear to be effective, and it’s not appropriate for everyone.

Ulcerative colitis is a form of inflammatory bowel disease that causes chronic inflammation of the digestive tract. Usually, only the innermost lining of the colon and rectum is affected. Symptoms of ulcerative colitis can vary, depending on the severity of the inflammation and where it occurs within the colon and rectum. Some common symptoms include diarrhea, abdominal pain and cramping, and fatigue. Typically, symptoms of ulcerative colitis come and go, with active periods of acute illness often alternating with periods of symptom-free remission.

Jonathan Leighton, M.D., Gastroenterology/Hepatology, Mayo Clinic, Scottsdale, Ariz.

Why Was This Study Needed

Ulcerative colitis causes inflammation and ulceration of the colon and rectum. It is thought to affect about 1 in 420 people in the UK. Some observational studies have suggested that people who smoke are less likely to develop ulcerative colitis than people who do not smoke, or who used to smoke. It is unclear why this is.

Previous evidence looking at the effect of smoking on people with ulcerative colitis has been inconclusive. A meta-analysis of 16 studies from 2016 found no evidence that smoking reduced disease progression or flares. However, other studies which tended to focus on specialist services, did find an effect. Some people with ulcerative colitis believe smoking helps their symptoms and continue to smoke, for this reason, risking other poor health outcomes from tobacco use.

This study was designed to evaluate the effect of both smoking status and smoking cessation on disease outcomes for people with ulcerative colitis, treated in the community or specialist services.

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Impact Of Cigarette Smoking On The Gastrointestinal Tract Inflammation: Opposing Effects In Crohns Disease And Ulcerative Colitis

  • 1Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
  • 2Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile

Cigarette smoking is a major risk factor for gastrointestinal disorders, such as peptic ulcer, Crohns disease , and several cancers. The mechanisms proposed to explain the role of smoking in these disorders include mucosal damage, changes in gut irrigation, and impaired mucosal immune response. Paradoxically, cigarette smoking is a protective factor for the development and progression of ulcerative colitis . UC and CD represent the two most important conditions of inflammatory bowel diseases, and share several clinical features. The opposite effects of smoking on these two conditions have been a topic of great interest in the last 30 years, and has not yet been clarified. In this review, we summarize the most important and well-understood effects of smoking in the gastrointestinal tract and particularly, in intestinal inflammation, discussing available studies that have addressed the causes that would explain the opposite effects of smoking in CD and UC.

Creamy And Greasy Food

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Creamy and greasy foods containing loads of mayonnaise, butter, cream cheese, margarine, animal fat, etc. can irritate the inner lining of the colon. This can worsen the ulcers and may cause rectal bleeding. Avoid creamy pasta, macaroni and cheese, and creamy cheese containing foods to pacify your colon.

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Should I Stop Smoking

On average, even light smokers with Crohns have higher risks of surgery and complications than do nonsmokers. In the words of one MyCrohnsAndColitisTeam member, My advice: Quit smoking if you can, because it’ll only get worse not to mention the other problems with smoking!

Smoking cessation is beneficial for people with Crohns disease. Several studies show that interventions designed to help people quit smoking improved their symptoms. Promisingly, researchers have found that the diseases course in ex-smokers is comparable to the course of people who have never smoked. Once a person with Crohns has stopped smoking for a year, their chances of a disease flare-up may be as low as that of someone with Crohns who has never smoked.

History Of Ulcerative Colitis

History doesnt reveal who first described UC. Physicians, like Soranus and Aretaeus , mentioned various types of non-contagious diarrhea in Roman literature. In 1745, Prince Charles, the Young Pretender, had UC and cured himself of the condition by adopting a dairy-free diet.

In 1859, the condition was first referred to by that name by Sir Samuel Wilks. Years later, the Surgeon General of the Union Army also called the disease ulcerative colitis. By 1909, London hospitals collated 300 cases of UC. In 1965, Evans and Acheson suggested that the disease affects around one in 1,000 of the general population.

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Nicotine May Reduce Inflammation

Researchers believe that although cigarette smoke contains many dangerous compounds, nicotine itself may have some anti-inflammatory effects. This may reduce the swelling, irritation, and sores in the large intestine that occur in people with UC.

More studies are being done to discover how nicotine or other components of cigarette smoke may be beneficial for UC. Once scientists find the answers, they may be able to use them to develop new treatments for UC. These treatments could reduce the risk of UC without the life-threatening hazards of smoking.

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