| Autor: |
Lawrance, Ian C., Murray, Kevin, Batman, Birol, Gearry, Richard B., Grafton, Rachel, Krishnaprasad, Krupa, Andrews, Jane M., Prosser, Ruth, Bampton, Peter A., Cooke, Sharon E., Mahy, Gillian, Radford-Smith, Graham, Croft, Anthony, Hanigan, Katherine |
| Zdroj: |
Journal of Crohn's & Colitis; Dec2013, Vol. 7 Issue 12, pe665-e671, 0p |
| Abstrakt: |
Abstract: Background: Smoking increases CD risk. The aim was to determine if smoking cessation at, prior to, or following, CD diagnosis affects medication use, disease phenotypic progression and/or surgery. Methods: Data on CD patients with disease for ≥5yrs were collected retrospectively including the Montreal classification, smoking history, CD-related abdominal surgeries, family history, medication use and disease behaviour at diagnosis and the time when the disease behaviour changed. Results: 1115 patients were included across six sites (mean follow-up—16.6yrs). More non-smokers were male (p=0.047) with A1 (p<0.0001), L4 (p=0.028) and perianal (p=0.03) disease. Non-smokers more frequently received anti-TNF agents (p=0.049). (p=0.017: OR 2.5 95%CI 1.18–5.16) and those who ceased smoking prior to diagnosis (p=0.045: OR 2.3 95%CI 1.02–5.21) progressed to complicated (B2/B3) disease as compared to those quitting at diagnosis. Patients with uncomplicated terminal ileal disease at diagnosis more frequently developed B2/B3 disease than isolated colonic CD (p<0.0001). B2/B3 disease was more frequent with perianal disease (p<0.0001) and if i.v. steroids (p=0.004) or immunosuppressants (p<0.0001) were used. 49.3% (558/1115) of patients required at least one intestinal surgery. More smokers had a 2nd surgical resection than patients who quit at, or before, the 1st resection and non-smokers (p=0.044: HR=1.39 95%CI 1.01–1.91). Patients smoking >3cigarettes/day had an increased risk of developing B2/B3 disease (p=0.012: OR 3.8 95%CI 1.27–11.17). Conclusion: Progression to B2/B3 disease and surgery is reduced by smoking cessation. All CD patients regardless of when they were diagnosed, or how many surgeries, should be strongly encouraged to cease smoking. [Copyright &y& Elsevier] |
| Databáze: |
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