INTRODUCTION It does not matter whether you live in England, Wales, Scotland, Scandinavia, America or Cyprus - the results of the studies are the same. People with Crohn’s Disease are more often than not smokers. In contrast, people with Ulcerative Colitis tend not to smoke. What are the facts behind smoking and IBD, and what does it mean?Studies on the relationship between smoking and Crohn’s disease have now been carried out in many countries by many workers. In almost all of them, half or more of adults with Crohn’s smoke. Compared with a non-smoker, the smoker has at least double the chance of getting Crohn’s. Women appear more at risk: in women in their twenties, the risk of getting Crohn’s is four to ten times as high as for a non-smoker; the risk is increased for men but not as much.
HOW DOES SMOKING PREDISPOSE TO CROHN’S? We do not know, although there are a lot of theories. It may be that nicotine alters the way blood flows through the gut, or alters the constitution of fluid secreted by the bowel, or it may directly inflame the lining layer of the bowel.
IS CROHN’S MORE SEVERE IN SMOKERS?
The answer is probably yes. In some studies symptoms have been more severe, and the ‘quality of life’ (which measures how much in the way of symptoms people are having) is worse in smokers, particularly women. Also, if people have had operations for Crohn’s, the chances of needing another operation over the next few years is nearly twice as high in smokers. In one American study, the number of days on which people felt symptoms was much less in non-smokers - 5 days per month rather than 15.
IF I AM A SMOKER NOW, DOES GIVING UP IMPROVE MY OUTLOOK?
The answer seems to be yes. In the non-smoker, Crohn’s disease seems milder. In a French study, amongst those who gave up smoking the chances of needing surgery were less than in those who persisted. There was less need for some of the stronger forms of medical treatment such as immunosuppressant drugs. After giving up smoking, the chance of a relapse is probably as low as for a non-smoker.
WHAT ABOUT ‘PASSIVE SMOKING’ AND THE RISK TO CHILDREN <>Although it is not so clear, there is some suggestion that exposure to cigarette smoke in childhood may predispose to getting Crohn’s.
ARE THESE FACTS TRUE ALL OVER THE WORLD?
In Israel, where there is a lot of Crohn’s disease because there appears to be a strong genetic tendency to develop the condition among Jewish people, the association with smoking has not been found. It has been suggested that this may be because the genetic tendency there is so strong that the trigger of smoking is not necessary.
SMOKING AND ULCERATIVE COLITIS Surprisingly, the situation seems quite different for ulcerative colitis. Most patients with colitis do not smoke - only about 12% of adults with colitis smoke. In fact, it seems that some people develop colitis when they have been smokers and then give up. Particularly this seems to be true for middle-aged men.
DOES THIS MEAN I SHOULD TAKE UP SMOKING IF I HAVE COLITIS? No! Smoking would continue to put you at increased risk of chronic bronchitis, lung cancer, other cancers, and premature cardiovascular disease (heart attack and stroke).
DOES THIS RELATIONSHIP BETWEEN NON-SMOKING AND COLITIS HELP ME IN ANY WAY IF I HAVE COLITIS?
Researchers have tried the effects of nicotine in treating colitis. Nicotine can be given either as chewing gum, or in the form of nicotine patches. The results are fairly consistent in the studies. For mildly or moderately active ulcerative colitis, nicotine patches or gum do help. In a UK study, compared with a dummy preparation, over half of the people who were given nicotine improved markedly over six weeks, compared with less than a quarter on the dummy. Similar findings were seen in a study just published from the USA. However, not everybody could tolerate nicotine. Nearly 10% could not put up with side-effects - nausea, light-headedness, headache or shakiness. Also, although nicotine seemed to help in active disease, nicotine did not seem to help when it was given as ‘maintenance’, to keep colitis in remission.
SHOULD I USE NICOTINE TO TREAT MY ULCERATIVE COLITIS?
There is no definite answer. Discuss it with your GP and your specialist. If you developed ulcerative colitis after you gave up smoking, and have a flare-up, it is a logical treatment to try and it may well help. Do not expect too much though - one study has shown that it is not as effective as the drug prednisolone for treating active disease.
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Crohns and Colitis info 
