By Anne Harding
NEW YORK (Reuters Health) - 16/8/2019
A new study adds to evidence that smoking does not improve disease outcomes in ulcerative colitis (UC) and that kicking the habit will not worsen the disease, as some have thought.
"Physicians should feel much more confident in advising patients not to smoke, and that actually they should be able to reassure patients who are worried about quitting smoking that it's not going to increase their need for medication and surgery," Dr. Jonathan Blackwell of St. George's Healthcare NHS Trust and St. George's University in London, U.K., told Reuters Health by phone. "There are lots of treatment options for ulcerative colitis, but smoking is not one of them."
Smokers are about half as likely to develop UC compared with non-smokers, Dr. Blackwell and his team note in Alimentary Pharmacology and Therapeutics, online August 7. But studies of whether smoking affects outcomes in patients with UC, or if quitting leads to worse disease, have had mixed results.
The researchers used the Clinical Practice Research Datalink, a nationally representative database, to identify 6,754 patients diagnosed with UC in 2005-2016 for whom data on smoking status was available. About 40% had never smoked, 47% were ex-smokers, and 13% were smokers.
Risks of corticosteroid-requiring flares, thiopurine use, corticosteroid dependency, hospitalization and colectomy were similar for smokers and never-smokers, the authors found. And smokers who quit after UC diagnosis did not have an increased risk of these outcomes compared with those who kept smoking.
"We can definitely say in terms of these actual outcomes long-term that it's not going to be of benefit to you to carry on smoking," Dr. Blackwell said.
Patients with Crohn's disease (CD) who smoke are at increased risk of needing surgery, he added.
European guidelines underscore the importance of smoking cessation for CD patients, who are at increased risk of surgery if they smoke, the researcher noted. Similar advice should be added to guidelines on UC, which don't mention smoking, he added, pointing out that one study found fewer than 3% of UC patients who smoke received quitting help.
Aliment Pharmacol Ther 2019.
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