Digestive Diseases Clinical Academic Unit, Barts and the London School of Medicine and Dentistry, UK.
Eur J Gastroenterol Hepatol. 2011 Jan;23(1):90-4. doi: 10.1097/MEG.0b013e32834108ce.
Smoking is a risk factor for developing Crohn's disease (CD) and worsens its outcome. Conversely, in ulcerative colitis (UC), the onset may be triggered by the smoking cessation and smoking may be beneficial. To help to ascertain whether patients with inflammatory bowel disease (IBD) would benefit from attending a smoking cessation clinic, we assessed: first, the prevalence of smoking; second, patients' awareness of the effects of smoking, and finally nicotine dependence in IBD patients compared with the healthy and disease-matched controls.
A total of 246 consecutive IBD outpatients (173 patients with CD, 73 patients with UC) completed a questionnaire on smoking habits and its effect on IBD. Smokers were assessed for dependence using the Fagerstrom test for nicotine dependence (FTND) score and their results were compared with those of age, sex, and ethnicity-matched healthy (five controls for each IBD patient) and asthma controls (one control for each IBD patient) attending a smoking cessation clinic.
Thirty five out of 173 patients (20%) with CD and nine out of 73 patients (12%) with UC were current smokers, with 52 out of 173 patients (30%) with CD and 28 out of 73 patients (38%) with UC being ex-smokers. Ninety out of 173 patients (52%) with CD knew that smoking worsens CD, whereas only 15 out of 73 patients (21%) with UC knew of the beneficial effects of smoking on their disease (P=0.032). Knowledge was unrelated to smoking status. In patients with CD, the median (range) FTND score was 3 (0-8) compared with 7 (2-10) in healthy (P<0.001) and 6 (2-9) in asthma controls (P<0.0001). Only seven of the 35 (20%) smoking patients with CD were highly dependent (FTND score ≥6). Similarly, in the patients with UC, the FTND score was 1 (0-4), lower than in healthy, [6 (2-10)], and asthma controls, [7 (4-10); (P<0.004 for both groups)].
Patients with CD were better informed about the effects of smoking on their own disease than the patients with UC. Nicotine dependence in IBD patients is lower than in smokers' clinic clients and comparable with that of the general population. Their low nicotine dependence suggests that most IBD patients could be weaned off the smoking habit successfully in the IBD clinic and referral to a smoking cessation clinic was offered to the highly dependent minority and others expressing interest in attending.
吸烟是克罗恩病（CD）发病的危险因素，并可使 CD 的预后恶化。相反，在溃疡性结肠炎（UC）中，吸烟可能会引发疾病的发作，而戒烟可能对其有益。为了确定炎症性肠病（IBD）患者是否会从戒烟门诊中获益，我们评估了：IBD 患者的吸烟流行率；其次，评估了患者对吸烟影响的认识；最后，评估了 IBD 患者与健康人群和疾病匹配对照者的尼古丁依赖程度。
对 246 例连续的 IBD 门诊患者（173 例 CD 患者，73 例 UC 患者）进行了吸烟习惯及其对 IBD 影响的问卷调查。采用尼古丁依赖 Fagerstrom 测试（FTND）评分评估吸烟者的依赖程度，将其结果与年龄、性别和种族匹配的健康对照者（每位 IBD 患者 5 名对照者）和哮喘对照者（每位 IBD 患者 1 名对照者）进行比较，这些对照者均在戒烟门诊就诊。
173 例 CD 患者中有 35 例（20%）为当前吸烟者，73 例 UC 患者中有 9 例（12%）为当前吸烟者，173 例 CD 患者中有 52 例（30%）为既往吸烟者，73 例 UC 患者中有 28 例（38%）为既往吸烟者。173 例 CD 患者中有 90 例（52%）知道吸烟可使 CD 恶化，而 73 例 UC 患者中仅有 15 例（21%）知道吸烟对其疾病有益（P=0.032）。知识与吸烟状态无关。在 CD 患者中，中位数（范围）FTND 评分为 3（0-8），而健康对照者为 7（2-10）（P<0.001），哮喘对照者为 6（2-9）（P<0.0001）。在 35 名吸烟的 CD 患者中，只有 7 名（20%）为高度依赖者（FTND 评分≥6）。同样，UC 患者的 FTND 评分为 1（0-4），低于健康对照者[6（2-10）]和哮喘对照者[7（4-10）]（两组均 P<0.004）。
CD 患者对吸烟对自身疾病影响的了解程度要好于 UC 患者。IBD 患者的尼古丁依赖程度低于戒烟门诊就诊者，与普通人群相当。他们的尼古丁依赖程度较低表明，大多数 IBD 患者可在 IBD 门诊成功戒烟，对尼古丁依赖程度高的少数患者和其他有戒烟意愿的患者可转介至戒烟门诊。
