Tobacco Use Is Associated With Accelerated Clinical Recurrence of Crohnʼs Disease After Surgically Induced Remission

GOALS:To study the association between tobacco exposure and postoperative clinical recurrence in Crohnʼs disease patients and quantify the time to clinical relapse following surgical resection. BACKGROUND:It is well accepted that cigarette smoking has a negative impact on postoperative course in Crohnʼs disease. However, the effect of smoking to hasten clinical recurrence has not been clearly delineated. STUDY:We reviewed medical records of patients undergoing surgical resection for medication-refractory disease within a 5-year period. Patients were followed for a period of 250 weeks. Outcomes were compared between smokers and nonsmokers and stratified by gender. RESULTS:Fifty-nine patients were studied. Sixty-nine percent of smokers versus 23% of nonsmokers had recurrent symptoms (P = 0.02) by the end of the observation period. There was no difference in the mean ages, gender, disease location, use of postoperative medications, or number of postoperative visits (P > 0.09). Smoking was associated with an increased risk of clinical recurrence [odds ratio 2.96 (95% confidence interval, CI 1.5-5.6)]. The time to clinical relapse for smokers was 130 weeks versus 234 weeks in nonsmokers (P < 0.001). CONCLUSION:Smoking is associated with clinical recurrence of Crohnʼs disease, and the time to clinical recurrence in smokers is shorter. Strategies for smoking cessation are warranted.