Smoking and Crohn's Disease
There is now incontrovertible evidence that smoking and Crohn's disease don't mix.
Researchers have known for a long time that people who have Crohn's disease are more likely to be smokers but that didn't prove that smoking caused or worsened Crohn's disease. Over the years the evidence has been mounting and now we can say without any doubt that smoking worsens Crohn's disease. If you are a smoker, the good news is that giving up smoking is as good as taking medicine to stop it from coming back. Quitters have a 65% lower risk of flare-up than continuing smokers. That is the kind of benefit conferred by drugs like Imuran. That is worth repeating - if you give up smoking, the benefit is as great as if you take medications to stop the disease from flaring up again. Put another way, you are less likely to need steroids or other immunosuppressive medications if you give up smoking.
What are the effects of smoking on Crohn's disease?
People who have Crohn's disease and smoke have more problems than those who don't smoke. There is a greater risk of developing abscesses and/or fistulae in smokers. Even when you are well, and the Crohn's disease is under control, the chances of it coming back again are increased by 50-100% if you smoke. The more you smoke the more likely it is to come back again.
Also, smokers are more likely to need the more powerful immunosuppressive therapy to keep things under control than non-smokers.
People who have Crohn's disease and smoke have a greater chance of needing surgery. In fact, the risk of needing surgery is almost twice as high if you smoke than if you don't (73% vs 39% in a study from Germany).
People who have Crohn's disease and smoke have more problems after surgery than those who don't. The evidence - surgeons in the UK collated the results of ten studies involving over 1300 Crohn's disease patients and looked at the chances of Crohn's disease coming back after an operation. They compared those who smoked to those who didn't. There was at least two to three and perhaps up to six times the risk of Crohn's disease coming back post-operatively.
In addition, the more you smoke and the longer you have been a smoker, the greater the risk that it will come back again. This effect is greater in women than in men, but is present for both sexes.
You are not exposing only yourself to risks when you smoke. Children who develop Crohn's disease are more likely to have been exposed to passive smoking at home. The risk of developing Crohn's disease is greater, the more passive smoking the child was exposed to.
The same goes for children whose mothers smoke at the time of birth. Their risk of getting Crohn's disease goes up three times. The children of people who have Crohn's disease and who smoke are at a greater risk of getting Crohn's disease themselves (and I won't even start about the genetic side of things!).
Please understand that if you have Crohn's disease and you smoke:
Your Crohn's disease will be harder to control
You are more likely to develop an abscess or a fistula
You are more likely to need more powerful immunosuppressive drugs
Your Crohn's disease is more likely to come back again when things do come under control
You are more likely to need surgery
Your Crohn's disease is more likely to come back after surgery
You are more likely to need additional operations
Your children are more likely to develop Crohn's disease (even if they don't smoke)
The bottom line: Just don't smoke.
If I give up smoking, will this really help?
- The good news is, that if you have Crohn's disease and can give up smoking for a year, you wipe the slate clean. It is as if you had never smoked.
- If you give up smoking you are more likely to get by without immunosuppressive medications.
- Giving up smoking reduces the chance of having a flare of Crohn's disease by 65%!!!!
- It's not going to be easy to give up, but it will be worth it in the end!
How can I go about giving up smoking?
The first point we want to make to you is, that you must not feel bad about your smoking or guilty that you find it hard to give up. Smoking is a very difficult habit to break and some people find it harder than others. Although it is clear that smoking can affect your illness, it cannot be said that your illness would not have gone this way or that, or that you may not have required surgery if you had not smoked. All we have said is, that it is now known to increase chances of this or that, rather than smoking be a clear and absolute cause. So, first of all, don't make matters worse by feeling guilty.
The second point is that there are plenty of options available to make giving up easier.
We have listed the following suggestions to assist you, a relative or friend to begin the process.
The most commonly known program is;
The 'Quit Program', the National Enquiry Phone Number is; 131 848
You can also arrange for an information kit to be mailed out.
However, sometimes people need additional or alternative ways and here are some others;
Hypnotherapy - some people find the use of this technique much less stressful or a good support to other methods. Contact The Australian Hypnotherapists' Association; National Information Line: 1800 067 557
Nicotine patches - these can help enormously with getting over the craving, however, you will need to discuss with your doctor because of your IBD.
Special Chewing gum - is another option, again discuss with your doctor.
Cognitive-behavioral programs - Psychologists with specialist training can conduct well-researched strategies for habit management and symptom relief.
Contact The Australian Psychological Society, the National Referral Service is free phone 1800 333 497. Ask for a psychologist in your state, nearest to where you live.
Acknowledgement to Mr. David Stokes, Manager, Professional Issues, The Australian Psychological Society for his contributions towards this important issue.
Kindly prepared by Dr.Paul Pavli, Gastroenterologist, Canberra, Australia.