Smoking is not an Independent Risk Factor for Surgery in Patients with Crohn’s Disease on Biologic Therapy
Introduction: The development and course of inflammatory bowel disease (IBD) appears to be influenced by environmental factors. Particularly, smoking has been shown to assume a harmful role in Crohn’s disease (CD) and a protective role in ulcerative colitis (UC). This study aims to examine the effec...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Karger Publishers
2023-04-01
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| Series: | Inflammatory Intestinal Diseases |
| Online Access: | https://www.karger.com/Article/FullText/530689 |
| _version_ | 1827949272002199552 |
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| author | Saleem Halablab Ayman Alrazim Christian Sadaka Hasan Slika Nour Adra Wissam Ghusn Manar Shmais Ala I. Sharara |
| author_facet | Saleem Halablab Ayman Alrazim Christian Sadaka Hasan Slika Nour Adra Wissam Ghusn Manar Shmais Ala I. Sharara |
| author_sort | Saleem Halablab |
| collection | DOAJ |
| description | Introduction: The development and course of inflammatory bowel disease (IBD) appears to be influenced by environmental factors. Particularly, smoking has been shown to assume a harmful role in Crohn’s disease (CD) and a protective role in ulcerative colitis (UC). This study aims to examine the effect of smoking on need for surgery in patients with moderate to severe Crohn’s disease (CD) receiving biologic therapy.
Methods: Retrospective study of adult patients with CD at a University Medical Center over a 20-year period.
Results: A total of 251 patients were included (mean age 36.0 ± 15.0; 70.1% males; current, former, and non-smokers: 44.2%,11.6%, and 43.8%, respectively). Mean duration on biologics was 5.0 ± 3.1 years (>2/3 received anti-TNFs, followed by ustekinumab in 25.9%) and a third of patients (29.5%) received more than one biologic. Disease-related surgeries (abdominal, perianal or both) occurred in 97 patients (38.6%): 50 patients had surgeries prior to starting biologics only, 41 had some surgeries after, and 6 had insufficient information. There was no significant difference in surgeries between ever-smokers (current or previous) vs. non-smokers in the overall study group. On logistic regression, the odds of having any CD surgery were higher in patients with longer disease duration (OR = 1.05, 95% CI = 1.01, 1.09) and in those receiving more than one biologic (OR = 2.31, 95% CI = 1.16, 4.59). However, among patients who had surgery prior to biologic therapy, smokers were more likely to have perianal surgery compared to non-smokers (OR = 10.6, 95% CI = 2.0, 57.4; p=0.006).
Conclusion: In biologic-naive CD patients requiring surgery, smoking is an independent predictor of perianal surgery. Smoking, however, is not an independent risk factor for surgery in this cohort after starting biologics. The risk of surgery in those patients is primarily associated with disease duration and the use of more than one biologic. |
| first_indexed | 2024-04-09T13:07:48Z |
| format | Article |
| id | doaj.art-39984f7f3e7b45779a6b33fe096012eb |
| institution | Directory Open Access Journal |
| issn | 2296-9403 2296-9365 |
| language | English |
| last_indexed | 2024-04-09T13:07:48Z |
| publishDate | 2023-04-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Inflammatory Intestinal Diseases |
| spelling | doaj.art-39984f7f3e7b45779a6b33fe096012eb2023-05-12T12:24:18ZengKarger PublishersInflammatory Intestinal Diseases2296-94032296-93652023-04-0110.1159/000530689530689Smoking is not an Independent Risk Factor for Surgery in Patients with Crohn’s Disease on Biologic TherapySaleem Halablabhttps://orcid.org/0000-0003-1545-7815Ayman AlrazimChristian SadakaHasan Slikahttps://orcid.org/0000-0003-4597-3642Nour AdraWissam Ghusnhttps://orcid.org/0000-0002-9389-6795Manar Shmaishttps://orcid.org/0000-0001-6924-6533Ala I. Shararahttps://orcid.org/0000-0003-0248-9527Introduction: The development and course of inflammatory bowel disease (IBD) appears to be influenced by environmental factors. Particularly, smoking has been shown to assume a harmful role in Crohn’s disease (CD) and a protective role in ulcerative colitis (UC). This study aims to examine the effect of smoking on need for surgery in patients with moderate to severe Crohn’s disease (CD) receiving biologic therapy. Methods: Retrospective study of adult patients with CD at a University Medical Center over a 20-year period. Results: A total of 251 patients were included (mean age 36.0 ± 15.0; 70.1% males; current, former, and non-smokers: 44.2%,11.6%, and 43.8%, respectively). Mean duration on biologics was 5.0 ± 3.1 years (>2/3 received anti-TNFs, followed by ustekinumab in 25.9%) and a third of patients (29.5%) received more than one biologic. Disease-related surgeries (abdominal, perianal or both) occurred in 97 patients (38.6%): 50 patients had surgeries prior to starting biologics only, 41 had some surgeries after, and 6 had insufficient information. There was no significant difference in surgeries between ever-smokers (current or previous) vs. non-smokers in the overall study group. On logistic regression, the odds of having any CD surgery were higher in patients with longer disease duration (OR = 1.05, 95% CI = 1.01, 1.09) and in those receiving more than one biologic (OR = 2.31, 95% CI = 1.16, 4.59). However, among patients who had surgery prior to biologic therapy, smokers were more likely to have perianal surgery compared to non-smokers (OR = 10.6, 95% CI = 2.0, 57.4; p=0.006). Conclusion: In biologic-naive CD patients requiring surgery, smoking is an independent predictor of perianal surgery. Smoking, however, is not an independent risk factor for surgery in this cohort after starting biologics. The risk of surgery in those patients is primarily associated with disease duration and the use of more than one biologic.https://www.karger.com/Article/FullText/530689 |
| spellingShingle | Saleem Halablab Ayman Alrazim Christian Sadaka Hasan Slika Nour Adra Wissam Ghusn Manar Shmais Ala I. Sharara Smoking is not an Independent Risk Factor for Surgery in Patients with Crohn’s Disease on Biologic Therapy Inflammatory Intestinal Diseases |
| title | Smoking is not an Independent Risk Factor for Surgery in Patients with Crohn’s Disease on Biologic Therapy |
| title_full | Smoking is not an Independent Risk Factor for Surgery in Patients with Crohn’s Disease on Biologic Therapy |
| title_fullStr | Smoking is not an Independent Risk Factor for Surgery in Patients with Crohn’s Disease on Biologic Therapy |
| title_full_unstemmed | Smoking is not an Independent Risk Factor for Surgery in Patients with Crohn’s Disease on Biologic Therapy |
| title_short | Smoking is not an Independent Risk Factor for Surgery in Patients with Crohn’s Disease on Biologic Therapy |
| title_sort | smoking is not an independent risk factor for surgery in patients with crohn s disease on biologic therapy |
| url | https://www.karger.com/Article/FullText/530689 |
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