Gastroenterologists Inconsistently Assess for and Advise Against Tobacco use in Patients With Inflammatory Bowel Disease

Abstract

Tobacco use can influence the expression of inflammatory bowel disease (IBD). It has been reported that smoking decreases ulcerative colitis exacerbations and increases symptoms in individuals with Crohn's disease. While improvement in ulcerative colitis expression can occur with tobacco use, the overall negative health effects of tobacco warrant smoking cessation counseling. This study evaluated the rate at which gastroenterologists assessed tobacco use and counseled against smoking in IBD patients. Medical records of consecutive patients seen in an IBD program at a university gastroenterology practice were evaluated. Patient age, gender, race, disease type (ulcerative colitis, Crohn's disease), tobacco use and smoking cessation counseling were obtained. A database, maintaining patient confidentiality, was created using Microsoft Excel. Statistical analysis was performed using Fisher Exact test and t-test, with significance set at P < 0.05. Medical records of 343 IBD patients were evaluated. 22 (6.4%) were smokers, 20 (5.8%) were former smokers and 272 (79%) were non-smokers. 29 (8.4%) had no documented smoking status. Of the 22 smokers, 15 patients had Crohn's disease and 7 had ulcerative colitis. 12 of the 22 (54%) smokers were counseled against smoking while 10 (46%) had no documented smoking cessation counseling. Two ulcerative colitis patients were counseled to continue smoking to control their symptoms and 1 former smoker was counseled to consider resuming tobacco use if his symptoms were not controlled with aminosalicylates. While smoking has been reported to be associated with decreased symptoms in ulcerative colitis patients, tobacco use has significant deleterious health effects. All IBD patients should be assessed for tobacco use and counseled against smoking. However, this study revealed that gastroenterologists inconsistently evaluated IBD patients for smoking. Additionally, in the patients who smoked, only half were counseled to stop. Notably, 10% of the ulcerative colitis patients who smoked or previously smoked were advised to consider continuing tobacco use to control their symptoms. While this study is limited due to sample size and retrospective design with reliance on documentation, it provides a foundation for further research into the complexities of tobacco use and IBD. It is important that a tobacco history be obtained from all patients, that patients are advised of the hazards of smoking, and that tobacco not be considered a therapeutic option in IBD management.