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Smoking in inflammatory bowel diseases:Good,bad or ugly?

World Journal of Gastroenterology 2007年第46期13卷 6134-6139页

作者： Peter Laszlo Lakatos tamas szamosi Laszlo Lakatos Department of Medicine Semmelweis UniversityBudapestHungary Department of Medicine Csolnoky F.County HospitalVeszpremHungary

Smoking is an important environmental factor in inflammatory bowel disease （IBD）, having different effects in ulcerative colitis （UC） and Crohn＇s disease （CD）. A recent meta-analysis partially confirmed previous findings that smoking was found to be protective against ulcerative colitis and, after onset of the disease, might improve its course, decreasing the need for colectomy. However, smoking increases the risk of developing Crohn＇s disease and worsens its course, increasing the need for steroids, immunosuppressants and re-operations. Smoking cessation aggravates ulcerative colitis and improves Crohn＇s disease. Data are however, largely conflictive as well as the potential mechanisms involved in this dual relationship are still unknown. In this review article, the authors review the role of smoking in inflammatory bowel diseases.

关键词： Smoking Crohn's disease Ulcerative colitis Phenotype

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Perianal disease,small bowel disease,smoking,prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn's disease

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World Journal of Gastroenterology 2009年第28期15卷 3504-3510页

作者： Peter Laszlo Lakatos Zsofia Czegledi tamas szamosi Janos Banai Gyula David Ferenc Zsigmond Tunde Pandur Zsuzsanna Erdelyi Orsolya Gemela Janos Papp Laszlo Lakatos 1st Department of Medicine Semmelweis University H-1083 Budapest Hungary Department of Gastroenterology State Health Center H-1062 Budapest Hungary 1st Department of Medicine Csolnoky F. County Hospital HH8201-Veszprem Hungary

AIM:To assess the combined effect of disease phenotype, smoking and medical therapy [steroid, azathioprine(AZA), AZA/biological therapy] on the probability of disease behavior change in a Caucasian cohort of patients with Crohn's disease(CD).METHODS:Three hundred and forty well-characterized, unrelated, consecutive CD patients were analyzed(M/F:155/185, duration:9.4 ± 7.5 years) with a complete clinical *** records including disease phenotype according to the Montreal classification, extraintestinal manifestations, use of medications and surgical events were analyzed *** were interviewed on their smoking habits at the time of diagnosis and during the regular follow-up ***:A change in disease behavior was observed in 30.8% of patients with an initially non-stricturing, non-penetrating disease behavior after a mean diseaseduration of 9.0 ± 7.2 *** a logistic regression analysis corrected for disease duration, perianal disease, smoking, steroid use, early AZA or AZA/ biological therapy use were independent predictors of disease behavior *** a subsequent Kaplan-Meier survival analysis and a proportional Cox regression analysis, disease location(P = 0.001), presence of perianal disease(P < 0.001), prior steroid use(P = 0.006), early AZA(P = 0.005) or AZA/biological therapy(P = 0.002), or smoking(P = 0.032) were independent predictors of disease behavior ***:Our data suggest that perianal disease, small bowel disease, smoking, prior steroid use, early AZA or AZA/biological therapy are all predictors of disease behavior change in CD patients.

关键词： Crohn's disease Smoking Azathioprine Infliximab Monoclonal antibodies Colectomy Risk Reoperation

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