Smoking and Crohn’s Disease Relapse

A study found smokers with Crohn’s disease are more likely to have a relapse after surgery.

Becoming a non-smoker is particularly important for people who have Crohn’s disease.

Researchers at the University of Edinburgh found that people who had Crohn’s disease and were also smokers were more likely to have a relapse after surgery.

Crohn’s disease is an inflammatory bowel condition in which the immune system attacks the lining of the gut. Symptoms include abdominal pain, nausea, vomiting, diarrhea and lethargy.

Crohn’s disease is usually treated initially with medications called thiopurines. This treatment decreases the immune system response. However, more than half of all patients with Crohn’s disease eventually require surgery.

Researchers wanted to evaluate whether administering thiopurines after surgery would help prevent relapse. In addition to evaluating the effect of the medication the researchers collected data on lifestyle factors like smoking.

“Our study confirms that the most important thing somebody with Crohn’s disease can do for their health is not to smoke,” lead author Jack Satsangi, PhD, said in a press release. “People who are unable to quit smoking are at high risk of relapse after surgery and may begin treatment with thiopurines immediately after their operation.”

Dr. Satsangi and colleagues studied 240 people with Crohn’s disease for three years after they had undergone surgery. Of the study subjects, 128 were treated with a thiopurine and 122 received a placebo.

Patients in the smoking group were more likely to relapse, but treating them with thiopurine decreased the likelihood of relapse. Non-smokers had a much lower relapse rate than smokers.

“For non-smokers, however, we found that thiopurines offer little benefit at preventing relapse after surgery,” Dr. Satsangi said. “For these patients, close monitoring in the first year is the best course of action, rather than immediate drug therapy.”

The study was published in the September issue of The Lancet, Gastroenterology and Hematology.

Funding for the study was provided by the Medical Research Council and National Institute of Health Research’s Efficacy and Mechanism Evaluation Programme, the Scottish Government Chief Scientist Office and the National Institute of Health Research National Portfolio.

None of the authors reported a conflict of interest.

University of Edinburgh, “Smokers more prone to bowel condition relapses, study suggests”
The Lancet, “Mercaptopurine versus placebo to prevent recurrence of Crohn’s disease after surgical resection (TOPPIC): a multicentre, double-blind, randomised controlled trial”

Written by: Beth Greenwood, RN | Medically Reviewed by: Dr. Robert Carlson, M.D.