Association of Smoking and Crohn's Disease: An Update
Abstract
The relationship between smoking and inflammatory bowel disease (IBD), which has been widely studied for years, is complex and different in Crohn's disease (CD) and ulcerative colitis (UC). The negative effect on CD, not only on disease progression and post-surgical recurrence, but also on post-surgical complications after intestinal resection, on its influence on the reservoir and on the modification of the natural evolution of CD towards fistulizing and stenosing forms, makes a proper approach to the problem imperative. With the rise of biologics, the influence of smoking on the response to these drugs has been studied. Although some studies have found a worse response to these treatments in patients who smoke, it is unclear whether the response to biologics worsens, or whether it is simply a worsening of the underlying disease with a consequent reduced response to the drugs used. Furthermore, regarding the safety of biologics and small molecule drugs in smokers, smoking may worsen adherence to these treatments, increase their adverse effects and contribute to an increased risk of thrombosis in patients with Janus-kinase (JAK) inhibitors. Because of its high preventable morbidity and mortality, it is essential that patients with CD stop smoking. Patients should be informed by their physician and governmental strategies should be promoted to facilitate both cessation and to reduce the risk of relapse.
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