Published online Aug 7, 2020. doi: 10.3748/wjg.v26.i29.4343
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
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.
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.
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.
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.
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.
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.
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.