S39 Use of Electronic Cigarettes in Inflammatory Bowel Disease: A Pilot Study

Abstract

Background: Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract likely involving both a genetic predisposition and environmental triggers. Cigarette smoking (CS) has well established links to IBD, as current and former use are risk factors for Crohn’s Disease (CD) and Ulcerative Colitis (UC) respectively. CS may result in increased use of glucocorticoids, immunosuppression and intestinal resection in patients with CD. Nicotine free e-cigarettes can induce gastrointestinal mucosal inflammation, impair the gut mucosal barrier and increase expression of pro-inflammatory cytokines. Data describing the use of e-cigarettes in IBD patients in the US is lacking. We conducted pilot study to determine prevalence and patterns of e-cigarette use in a large academic IBD practice. Methods: This was an IRB-approved study of adult patients with a confirmed diagnosis of IBD. Enrollment occurred in one of 2 arms: (1) MyChart Arm and (2) In-Person Arm. In Arm #1, a query of the electronic medical record (EMR) was performed of all IBD patients (using ICD-10 codes) with a clinic visit between 11/1/2020–10/31/2021. Using the MyChart research functionality within the EMR, eligible patients were directly contacted with a standardized recruitment message. Upon confirming interest, a personalized survey link was created via RedCap (research electronic data capture) and distributed to the patient via e-mail. In-person enrollment (Arm #2) was introduced in August of 2022. Eligible patients were approached by study staff during an existing IBD-related clinic visit. If interested, patients were provided a study information letter and a paper version of the survey to complete. Resulting data was then entered into the RedCap database. Survey questions elicited information regarding: (1) patient demographics, (2) description of current and former use of traditional tobacco products and of e-cigarettes, (3) duration and frequency of use, (4) product preference (5) perception of risk of e-cigarette use, and (6) interest in cessation. Results: A total of 62 patients completed the survey. The majority of our study population was female (n = 41/62; 66.1%), with a mean age of 39.3. Most patients reported a diagnosis of CD (n = 33/62; 53.2%). Approximately 2-thirds of respondents indicated they were “never” cigarette smokers (n = 41/62; 66.1%), and current use of traditional cigarettes was reported at 8.1% (5/62). E-cigarette use (former or current) was reported in 21.7% of patients (n = 13/60), with most beginning as adults (n = 12/13; 92.4%), and using multiple times per day (n = 10/13; 76.9%). Of those reporting e-cigarette use, the majority described their reason for use as “an attempt to quit use of a traditional tobacco product” (n = 7/13; 53.8%). Additionally, of those reporting e-cigarette use, majority considered e-cigarette use to be “less harmful” or “about the same” level of risk compared to CS (12/13; 92.3%). Conclusion(s): This pilot study establishes that e-cigarette use is prevalent in our large volume IBD academic practice, and may in fact be higher than cigarette smoking or other traditional tobacco products. A follow-up project is planned to evaluate implications of e-cigarette use on IBD-related disease outcomes.