Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2020; 26(29): 4343-4355
Published online Aug 7, 2020. doi: 10.3748/wjg.v26.i29.4343
Patients' perspectives on smoking and inflammatory bowel disease: An online survey in collaboration with European Federation of Crohn's and Ulcerative Colitis Associations
Catherine Le Berre, Laura Loy, Sanna Lönnfors, Luisa Avedano, Daniele Piovani
Catherine Le Berre, Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes 44000, France
Laura Loy, IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute, Rozzano, Milan 20089, Italy
Sanna Lönnfors, Luisa Avedano, European Federation of Crohn's and Ulcerative Colitis Associations, Brussels B-1000, Belgium
Daniele Piovani, Department of Biomedical Sciences, Humanitas University, Pieve Emanuele MI, Milan 20090, Italy
Daniele Piovani, Humanitas Clinical and Research Center - IRCCS, Milan, Rozzano 20089, Italy​
Author contributions: Le Berre C and Loy L was the conception and design of the study, interpretation of data, and drafting the article; Lönnfors S and Avedano L was the acquisition of data, making critical revisions related to important intellectual content of the manuscript; Piovani D was the analysis and interpretation of data, drafting the article; All authors read and approved the final version of the article to be published.
Supported by Philip Morris Products SA and coordinated by Linkt Health Ltd.
Institutional review board statement: An institutional review board statement is not necessary for this study as this is a survey.
Informed consent statement: This was an online survey. Before answering the questions, patients were informed of the objectives of the study and gave their consent online.
Conflict-of-interest statement: The authors declare no conflicts of interest relevant to this work.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement checklist of items, and the manuscript was prepared and revised according to the STROBE Statement checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Catherine Le Berre, MD, Doctor, Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, 1 place Alexis Ricordeau, Nantes 44000, France. catherine@leberre.org
Received: April 29, 2020
Peer-review started: April 29, 2020
First decision: May 13, 2020
Revised: May 25, 2020
Accepted: July 22, 2020
Article in press: July 22, 2020
Published online: August 7, 2020
Abstract
BACKGROUND

Smoking has detrimental effects on Crohn’s disease (CD) activity while data on ulcerative colitis (UC) are conflicting. Little is known about the use and impact of alternative smoking products in inflammatory bowel diseases (IBD).

AIM

To understand the patients’ perceptions of the impact of smoking on their IBD and to assess differences between CD and UC patients.

METHODS

The questionnaire was developed by Philip Morris Products SA in cooperation with European Federation of Crohn's and Ulcerative Colitis Associations. The final survey questionnaire consisted of 41 questions divided in 8 categories: (1) Subject screener; (2) Smoking history; (3) Background information; (4) IBD disease background; (5) Current disease status; (6) Current therapeutics and medications; and (7) Current nicotine/cigarettes use and awareness of the impacts of smoking on IBD. The questionnaire was submitted online from 4th November 2019 to 11th March 2020 through the European Federation of Crohn's and Ulcerative Colitis Associations website to IBD patients who were current smokers or had a history of smoking.

RESULTS

In total 1050 IBD patients speaking nine languages participated to the survey. Among them, 807 (76.9%) patients declared to have ever smoked or consumed an alternative smoking product, with a higher proportion of current cigarette smokers among CD patients (CD: 63.1% vs UC: 54.1%, P = 0.012). About two-thirds of the participants declared to have ever stopped cigarette smoking and restarted (67.0%), with a significantly higher proportion among UC patients compared to CD patients (73.1% vs 62.0%, P = 0.001). We also found significant differences between CD and UC patients in the awareness of the health consequences of smoking in their disease and in the perceived impact of smoking on disease activity, for both cigarettes and alternative smoking products.

CONCLUSION

This survey found significant differences between CD and UC patients in both awareness and perception of the impact of smoking on their disease. Further efforts should be done to encourage smoking cessation for all IBD patients, including UC patients.

Keywords: Inflammatory bowel disease, Ulcerative colitis, Crohn's disease, Cigarettes, Alternative smoking products, Tobacco, Nicotine, Marijuana

Core tip: We performed a European-wide online survey to understand the patients’ perceptions on how smoking has impacted their inflammatory bowel diseases (IBD). In total 1050 IBD patients [427 with Crohn’s disease (CD), 355 with ulcerative colitis (UC)] participated to the survey, with a higher proportion of cigarette smokers among CD patients. About two-thirds of the participants declared to have ever stopped cigarette smoking and restarted, with a higher proportion among UC compared to CD patients (73.1% vs 62.0%, P = 0.001). There were also differences between CD and UC patients in the awareness of the health consequences of smoking and in the perceived impact of smoking on disease activity.