Smoking Cessation May Affect Crohnʼs Disease Behavior and Quality of Life: A Pilot Study

Abstract

Introduction: Crohn's disease (CD) is a chronic progressive illness that affects many aspects of quality of life. Some studies have shown that smokers are at a higher risk for CD, while others showed that once diagnosed with CD, smokers may have a more aggressive disease. It is unclear if that effect is reversible by cessation of smoking. This study aims to look for any association between smoking cessation and CD in terms of disease behavior and quality of life. Methods: This is a prospective study conducted at a tertiary academic medical center in patients with known CD. Patients are asked to fill out a questionnaire that includes demographic data such as education, race, gender, duration of disease and employment status. They were also asked to fill out a Crohn's Disease Activity Index (CDAI) and Inflammatory Bowel Disease Questionnaire (IBDQ). CDAI was used to quantify the disease behavior, and includes clinical and laboratory data. IBDQ quantifies the quality of life in patients with IBD. In addition, patients were asked about smoking status and if they were interested in smoking cessation. Those interested were referred to the tobacco consultation service. Follow-up surveys will be given at 6 and 12 months to determine the difference in IBDQ and CDAI between the smokers, non-smokers and those who quit after referral to the smoking cessation. Results: This is a pilot study that has currently recruited 27 patients. The average age is 47.19 and about half are male and 85% Caucasian. There is a relatively even distribution of educational background. Four patients are smokers and only one of them is interested in quitting. The average length of time from diagnosis is 13.5 ± 9.59 years (Table 1). CDAI score average is 46.84 ± 43.54, categorizing all 27 as having a benign disease behavior with non-smokers having milder disease than smokers based on the CDAI. The average score of the IBDQ is 177.74 ± 36.71. Nonsmokers are found to have a better quality of life (Figure 1).Figure 1Conclusion: This study represents a pilot study at its beginning stage. While more patients will need to be recruited, it appears that smokers have a worse quality of life than non-smokers and have more aggressive disease. The next step will be to obtain more data in order to collect a statistically significant number of smokers. We will later collect follow-up data, particularly in patients who are able to quit smoking, to assess if smoking cessation will have tangible benefits to this patient group.Figure 2