Thursday, June 16, 2022

Smoking And Crohn’s Disease Ulcerative Colitis

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Risk Factors Associated With Ulcerative Colitis

Crohns disease and ulcerative colitis: Differences

This chronic condition has numerous risk factors. Just as many men as women develop ulcerative colitis over their lifetime. The following risk factors are associated with colitis:

Age Most cases of ulcerative colitis are diagnosed in adolescents and young adults however, it can occur at any age. Some surmise this may be due to the eating habits of the younger generation.

Race Inflammatory Bowel Disease often occurs in those with European and Jewish descent.

Family History Those who have a family history of inflammatory bowel disease are at an increased risk of developing this painful digestive disorder.

Medications Medications can increase the risk of developing ulcerative colitis. These medications include oral contraceptives, synthetic hormone replacement therapies and acne medications.

Place of Residence Where you live can contribute to a higher incidence of inflammatory bowel disease. Those who live in the United States and Europe have a higher risk of developing ulcerative colitis. Experts think this may be due to certain lifestyle factors, including pollution, diet and cigarette smoking.

Smoking Cessation In Ulcerative Colitis

Several studies have addressed whether smoking cessation has a negative impact on UC disease course. Analysis from the Nurses Health Study, a cohort of greater than 200,000 women over a 30 year period found that the hazard ratio for developing UC in the 25 year period following smoking cessation was 3.06 . A cohort study of 32 patients with UC who quit smoking, compared them to age and gender matched smokers and non smokers with UC with a mean follow-up of 9 years prior and 7 years post cessation of smoking. When comparing the time periods before and after smoking cessation, patients who smoked had fewer years with active disease , hospitalizations , and medical therapy . Use of immunomodulators was greater in the non-smoking cohort and those who had quit compared to those who continued to smoke , however there were no differences in the colectomy rates between the three groups.

So Do I Need To Give Up Smoking

It may be tempting to continue or even take up smoking to help your Colitis. However, research findings on smoking and Crohn’s or Colitis are mixed. We know that smoking increases your risk of chronic bronchitis, lung cancer, other cancers and heart diseases, and is not recommended by health professionals, even for people with Colitis. There are many treatments that are much safer than smoking that can be explored. For more information on drug therapies, please see our treatment information and our information on Other treatments for IBD.

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Former Smokers With Ulcerative Colitis Experience Fewer Symptoms When Lighting Up Again

Some studies have shown that former smokers who develop ulcerative colitis and then go back to smoking experience fewer symptoms. However, smoking itself carries other serious health risks. Physicians would not advise that a patient start smoking, as the risks of smoking far outweigh any possible benefit.

How Does Smoking Affect Crohns Disease

What are the differences between Crohn

In numerous studies, half or more of the adults with Crohns Disease were smokers when they were diagnosed. This suggests that people who smoke are more likely to get Crohns than those who do not smoke.

Research also suggests that smoking can make Crohns Disease worse. People with Crohns who smoke may find that they:

  • have more severe symptoms and complications such as strictures and fistulas
  • have more flare-ups
  • require more steroids and stronger drugs such as immunosuppressants and biologics. Sometimes these drugs are not as effective in people who smoke,
  • are more likely to need surgery
  • and are more likely to have to return for further surgery

Some studies suggest that women who smoke are more likely to develop Crohns Disease and to require surgery than men who smoke. Smoking has also been shown to have an association with disease location. Smokers tend to have Crohns Disease in the small intestine rather than the colon . Fundamental differences in the functions of the small and large bowel may explain this.

HOW DOES SMOKING MAKE YOU SUSCEPTIBLE TO CD?

We do not know, although there are lots of theories. Tobacco smoke contains over a thousand different chemicals including nicotine, carbon monoxide, and free radicals. There are several possible ways in which smoking may affect the gut it may lower the intestines defenses, decrease the blood flow in the intestines, or cause changes to the immune system which result in inflammation.

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Influence Of Smoking On Colonic Gene Expression Profile In Crohn’s Disease

  • Affiliation Department of Gastroenterology, Medical Section, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark

  • Affiliation Department of Gastroenterology, Medical Section, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark

  • Affiliation Department of Gastroenterology, Medical Section, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark

  • Affiliation Department of Clinical Biochemistry, Core Unit for Microarray Analyses, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

  • Affiliation Institute of Cellular and Molecular Medicine, Panum Institute, University of Copenhagen, Copenhagen, Denmark

Holistic Treatment For Ulcerative Colitis And Crohn’s Disease

Are you unable to manage your symptoms of Ulcerative Colitis or Crohns? Our functional medicine practitioners specialize in treatment of Inflammatory Bowel Diseases and can help you restore your GI health and experience a fulfilling life once again. We use a functional medicine approach to help identify root causes and create a customized treatment plan based on your health condition as well as family history, lifestyle, and diet.

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Effects Of Cigarette Smoke On The Gastrointestinal Tract

In addition to the respiratory and cardiovascular effects produced by cigarette smoke, several studies suggest that smoking is also harmful to the gastrointestinal tract, as summarized below . Cigarette smoke contains between 1014 and 1016 free radicals per puff , both in the gas phase and in the particulate phase. The active chemicals include aldehydes, quinones, benzopyrene, epoxides, and peroxides , which can induce the production of reactive oxygen species. If these are not neutralized by antioxidants, oxidative stress occurs, which causes tissue damage. Accordingly, it has been shown that cigarette smoking increases the incidence and relapse of peptic ulcer disease , and has been associated with IBD, CD, and the development of esophageal, stomach, liver, pancreatic, and colon cancer .

Table 1. Effects of cigarette smoke on the gastrointestinal tract.

Conversely, UC is a chronic and idiopathic inflammatory disorder of the colonic mucosa that begins in the rectum and usually extends proximally in a continuous manner through the entire colon or through a defined area. However, some patients with proctitis or left-sided colitis may have a cecal inflammation patch. Bloody diarrhea is the characteristic symptom of UC. The clinical course is unpredictable and is marked by alternating periods of exacerbation and remission .

IBD: Dissimilarities between CD and UC

Opposite Effects of Cigarette Smoking on CD and UC

Epidemiology

Proposed Mechanisms of Action

Effects Of Active And Passive Smoking On Disease Course Of Crohn’s Disease And Ulcerative Colitis

IBD School 207 Effect of Smoking and Nicotine on IBD

Reprints: Frans van der Heide, MD,Department of Gastroenterology and Hepatology, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands .

Gerard Dijkstra is supported by a clinical fellow grant from the Dutch Organization of Scientific Research .

Inflammatory Bowel Diseases

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Putative Mechanisms For The Role Of Smoking In Ibd

Despite the clear evidence for a link between smoking and IBD outlined above, the mechanisms that mediate these effects remain unclear. Cigarette smoke is highly complex and there is still uncertainty as to the role of specific components. Smoking appears to alter both the timing of onset of IBD and the course of disease itself. There are four key areas with relevance to the impact of smoking on IBD: the host GI microbiota, the integrity of the intestinal epithelium, the immune system and potentially epigenetic susceptibility.

Ulcerative Colitis And Diverticulitis: Whats The Outlook

UC is a lifelong condition, and your symptoms may come and go. About 30% of people with UC have severe symptoms, and flare-ups might happen more frequently. While medications often help, surgery may also be needed.

In contrast, most cases of diverticulitis, even though itâs also considered a lifelong condition, clear up with a 7- to 10-day course of antibiotics and plenty of rest. If you have severe symptoms, talk to your doctor about other treatment options.

Managing your diet and stress and making time for regular physical exercise are key to lowering your risks for both conditions. However, because some of the symptoms are specific, there are steps you can take to avoid your condition flaring up or getting worse.

To prevent diverticulitis, you should:

  • Eat more fiber. This helps your poop move better in your digestive tract and reduces any pressure on the colon walls
  • Drink lots of water, this prevents constipation.

If youâre not sure what to eat, talk to your doctor.

To lower your odds for UC or manage flare-ups, you should:

  • Get plenty of sleep. This can ease emotional stress and keep your immune system in check.
  • Avoid using too many nonsteroidal anti-inflammatory drugs . For pain relief and fever, switch to alternatives like acetaminophen .
  • Be careful when you take antibiotics. These drugs can trigger UC flare-ups. Let your doctor know if it does.

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Nicotine And Crohn’s Disease

Smoking cigarettes actually has a detrimental effect on Crohn’s disease. People who smoke, or who have smoked in the past, have a higher risk of developing Crohn’s disease than non-smokers.

Crohn’s disease patients that smoke has an increased number of relapses and repeat surgeries and may require aggressive immunosuppressive treatment. People with Crohn’s disease are strongly encouraged by their physicians to stop smoking in order to prevent flare-ups of the disease.

Talk With Others Who Understand

Crohns Disease vs Ulcerative Colitis : IBD

MyCrohnsAndColitisTeam is the social network for people with Crohns and ulcerative colitis and their loved ones. More than 140,000 members come together to ask questions, give advice, and share their stories with others who understand life with Crohns or ulcerative colitis.

Are you a smoker or former smoker living with ulcerative colitis? Share your experience in the comments below, or start a conversation by posting on MyCrohnsAndColitisTeam.

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How Is Treatment The Same And Different

In both conditions, treatments usually involve medications or, sometimes, surgery. In severe cases, your doctor may recommend a combination of the two to bring your symptoms under control. Certain over-the-counter medications may ease some of your pain-related symptoms. These include:

UC treatments may include:

Anti-inflammatory drugs. This is usually the first line of treatment. This can include drugs like 5-aminosalicylates and corticosteroids. Some newer drugs like sulfasalazine and 5-ASAs , which are called âsteroid-sparing,â can be safely taken long-term. Your doctor may not want you to take steroids long-term because of their side effects.

Immunosuppressant drugs. This helps to reduce inflammation in your colon and cut down the immune response that might attack your digestive cells.

Biologics. This targets the proteins made by your immune system.

Surgery. About 30% of people who have UC need surgery. Itâs sometimes the only cure, especially if medications donât ease your symptoms or they become too difficult to manage. Your doctor may consider a surgery called proctocolectomy.

In this procedure, your entire colon and rectum are removed. Most surgeries also involve a procedure in which your doctor will attach a pouch at the end of the small intestine or outside your body to pass poop directly into it.

Diverticulitis treatments may include:

What Is Ulcerative Colitis

Ulcerative colitis is one of the most common types of inflammatory bowel disease. This chronic disease causes inflammation and ulcers in the lower intestine. The ulcers usually form in the lower sections of the intestine, including the sigmoid colon and the rectum however, it can affect the whole colon. The more area of the colon that is affected, the worse the symptoms can become.

Although experts are not sure what causes ulcerative colitis, they speculate that it may be caused by the immune system attacking normal bacteria within the digestive tract. Other experts believe heredity can play a role in ulcerative colitis. This condition is common along family lines however, even those with no family history can develop ulcerative colitis.

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Mechanisms Of Action Of Nicotine

In spite of extensive investigation, the exact mechanisms involved in the therapeutic effects of nicotine in ulcerative colitis remain elusive. It has been reported that nicotine increases the thickness of colonic mucus, thus enhancing the protection of the intestinal mucosa , but this remains to be confirmed. A reduction in intestinal blood flow by nicotine has also been described , but it is unlikely that this phenomenon may account for the favourable effects of nicotine in ulcerative colitis, since rectal blood supply in ulcerative colitis patients is already lower than normal .

It has been suggested that nicotine influences the cellular and the humoral immune system and interferes with the inflammatory response, perhaps through stimulation of endogenous steroid release . Indeed nicotine has been found to suppress in vivo Th2 cell function as measured by inhibition of interleukin-10 production , and to reduce the synthesis of interleukin-2 and interleukin-8 by mononuclear cells.

Nicotine can affect gut motility , but the possible relevance of this effect to its activity in ulcerative colitis is unknown. Smoking appears to decrease intestinal permeability , but a similar effect by nicotine has not been demonstrated.

Crohns Disease And Smoking

Ulcerative Colitis versus Crohn’s Disease, Animation

Smoking is associated with a higher prevalence of Crohns and can increase the risk of developing it.1,2,3 These individuals who smoke also have a high risk of an increased disease severity, including increased relapse rates, a higher rate of corticosteroid, immunosuppressant, and biological drug use, narrowing of the gastrointestinal tract , increased rate of hospitalization and surgery, and more post-operative recurrence rates.4,5

A recently published study has also shown that peripheral arthritis is more common in people with Crohns who smoke or have a history of smoking .5

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Risk For Developing Crohns Disease

The percentage of current smokers in a group of patients with CD is significantly higher than that observed in a control population matched for sex and age . In concordance, an increased life-time risk was reported in current smokers when compared with non-smokers by both Calkins et al and in the more recent meta-analysis by Mahid et al .

Compared with never-smokers, former smokers were reported to have an increased risk of developing CD. This risk decreased only after four years of having quit smoking. In a recent population-based study by Bernstein et al, similar data were reported, both current smoking and ever smoking were associated with increased risk to develop CD. However, this later association could not be replicated in the recent meta-analysis by Mahid et al although a trend was observed . In contrast, ever smoking was associated with increased risk . The effect of passive smoking remains controversial. In one recent prospective study CD patients were more likely than controls to have prenatal smoke exposure . In addition, the passive smoke exposure during childhood, with parents or other household members being smokers was also associated with increased risk, in concordance with previous data by Lashner et al.

Disease Outcome In Uc

Active Smoking

The relation between smoking behavior and disease outcome variables in UC is depicted in . These data show a beneficial relation between active smoking and outcome in UC, except for pouchitis. Even with a longer follow-up, smoking UC patients had a lower colectomy rate, less PSC, and less backwash-ileitis than UC patients who never smoked. The development of pouchitis was not significantly different between smokers and never smokers, but patients who quit smoking before diagnosis had less pouchitis than smokers. Quitters before diagnosis had fewer hospitalizations and needed fewer oral steroids than quitters after diagnosis. Quitters before diagnosis more often had left-sided colitis and less often pancolitis during follow-up than never smokers.

Daily dose-effect of active smoking in ulcerative colitis. *P-value < 0.05 #P-value < 0.01 inflammation above proctum ¶azathioprine, 6-mercaptopurine, and/or methotrexate §hospitalizations once or more. 5-ASA: 5-aminosalicylates EIM: extraintestinal manifestations IQR: interquartile range IS: immunosuppressants PSC: primary sclerosing cholangitis.

Passive Smoking

We divided never-smoking UC patients into passive and nonpassive smokers. In contrast to the beneficial effect of active smoking, passive smokers developed more pouchitis and backwash-ileitis than nonpassive smokers . No effect of passive smoking was observed on the need for medication, surgery, and hospitalizations .

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General Harmful Effects Of Cigarette Smoking

The main component of cigarette, tobacco, is a natural product with a complex molecular composition. During smoking, this complex biomass is subjected to high temperatures and varying oxygen concentrations, producing an incomplete combustion that generates more than 7,000 toxic compounds. Cigarette smoke can be divided into mainstream and sidestream smoke. Mainstream smoke is the fraction that the smoker inhales directly, and is composed of a particulate phase and a gas phase . Low molecular weight components, such as carbon monoxide and light aldehydes, are the main substances present in the gas phase, which immediately enters the pulmonary circulation . On the other hand, compounds such as nicotine, polycyclic aromatic compounds, nitrosamines, and heavy metals are predominantly found in the particulate phase, which is absorbed by mucous membranes, skin, alveoli, and the gastrointestinal system .

Tolerability Of Transdermal Nicotine

Can You Have BOTH Crohns Disease and Ulcerative Colitis?  BayAreaCannabis

Adverse effects during therapy with transdermal nicotine were significantly more frequent than with placebo in all three placebo-controlled trials . The side-effects most commonly observed with nicotine were nausea, light-headedness, headache, sleep disturbances and skin irritation. The number of nicotine side-effects was significantly higher even compared with prednisolone but it must be noted that the steroid was employed at a dose of only 15 mg daily. When administered in standard doses corticosteroids were no better tolerated than nicotine .

In general adverse reactions occurred much more frequently in lifelong non-smokers than in former smokers and tended to appear especially during the first 2 weeks of therapy . Treatment withdrawals because of nicotine side-effects ranged from 5.7 to 13% .

Although no clear correlation was found between nicotine plasma levels and incidence of adverse effects , it appears that daily doses of nicotine up to 15 mg are better tolerated .

On the whole transdermal nicotine treatment results in frequent side-effects, although most patients are able to complete the course of therapy. No withdrawal symptoms suggesting nicotine addiction have been reported either after 46 weeks of therapy in short-term studies, or after a period of up to 6 months in the only long-term study available . Clearly, alternative nicotine formulations able to minimize the adverse effects of nicotine patches are of interest.

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