- 作者：Ian C. Lawrance ; Kevin Murray ; Birol Batman ; Richard B. Gearry ; Rachel Grafton ; Krupa Krishnaprasad ; Jane M. Andrews ; Ruth Prosser ; Peter A. Bampton ; Sharon E. Cooke ; Gillian Mahy ; Graham Radford-Smith ; Anthony Croft ; Katherine Hanigan
- 关键词：Smoking ; Crohn's disease ; Surgery ; Disease progression
- 刊名：Journal of Crohn's and Colitis
- 出版年：15 December, 2013
- 年：2013
- 卷：7
- 期：12
- 页码：e665-e671
- 全文大小：332 K
Background
Smoking increases CD risk. The aim was to determine if smoking cessation at, prior to, or following, CD diagnosis affects medication use, disease phenotypic progression and/or surgery.Methods
Data on CD patients with disease for 鈮?#xA0;5 yrs were collected retrospectively including the Montreal classification, smoking history, CD-related abdominal surgeries, family history, medication use and disease behaviour at diagnosis and the time when the disease behaviour changed.
Results
1115 patients were included across six sites (mean follow-up鈥?6.6 yrs). More non-smokers were male (p = 0.047) with A1 (p < 0.0001), L4 (p = 0.028) and perianal (p = 0.03) disease. Non-smokers more frequently received anti-TNF agents (p = 0.049). (p = 0.017: OR 2.5 95%CI 1.18-5.16) and those who ceased smoking prior to diagnosis (p = 0.045: OR 2.3 95%CI 1.02-5.21) progressed to complicated (B2/B3) disease as compared to those quitting at diagnosis. Patients with uncomplicated terminal ileal disease at diagnosis more frequently developed B2/B3 disease than isolated colonic CD (p < 0.0001). B2/B3 disease was more frequent with perianal disease (p < 0.0001) and if i.v. steroids (p = 0.004) or immunosuppressants (p < 0.0001) were used. 49.3% (558/1115) of patients required at least one intestinal surgery. More smokers had a 2nd surgical resection than patients who quit at, or before, the 1st resection and non-smokers (p = 0.044: HR = 1.39 95%CI 1.01-1.91). Patients smoking > 3 cigarettes/day had an increased risk of developing B2/B3 disease (p = 0.012: OR 3.8 95%CI 1.27-11.17).
Conclusion
Progression to B2/B3 disease and surgery is reduced by smoking cessation. All CD patients regardless of when they were diagnosed, or how many surgeries, should be strongly encouraged to cease smoking.