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
Research background

Environmental factors are probably primarily responsible for the growing incidence of inflammatory bowel diseases (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), around the globe over the last decades. Among these factors, smoking is the one for which the most solid evidence is currently available. Smoking increases the risk of CD and worsens its clinical course but has a protective effect in UC.

Research motivation

Until now, there has been little patient-centered research aiming at assessing the perceived impact of smoking or nicotine use on IBD symptoms by patients who are current adult smokers and/or nicotine-containing products users. Few studies demonstrated that a high proportion of patients with IBD are unaware of the effects of tobacco on their disease, but these limited available data are solely based on small-scale studies. Yet, making patients aware of the impact of nicotine use on the course of their IBD is essential to expect smoking cessation and improve the management of their disease.

Research objectives

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

Research methods

This was a European-wide online survey developed by Philip Morris Products SA in collaboration with European Federation of Crohn’s and Ulcerative Colitis Association. 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 survey was made available in English, French, German, Spanish, Portuguese, Italian, Greek, Finnish and Slovenian. The online survey was open from 4th November 2019 to 11th March 2020 on the European Federation of Crohn’s and Ulcerative Colitis Association website.

Research results

This survey enrolled 1050 IBD patients speaking nine different languages. Among them, 807 declared to have ever smoked or consumed an alternative smoking product. More than half were current cigarette smokers (59.0%). This proportion was significantly higher in CD than in UC patients. There were no significant differences in the use of any nicotine-containing product between CD and UC patients. The perception of the impact of cigarette smoking significantly differed between CD and UC patients. Similarly, the perceived impact of using alternative smoking products on disease activity significantly differed between CD and UC patients. Among patients having ever smoked cigarettes, 31.7% did not receive any information from their physician on the effect of smoking on disease activity, while 45.4% of them received the information that smoking is detrimental to disease activity. These proportions were significantly different in CD and in UC patients.

Research conclusions

We 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, because of the well-established beneficial effects of smoking cessation on general health.

Research perspectives

In light of the increasing use of alternative nicotine-containing products, like e-cigarettes, further studies are mandatory to explore the safety and impact of these products in patients with IBD.