Cigarette smoking increases colorectal neoplasia risk in IBD
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Patients with inflammatory bowel disease who either currently or formerly smoked cigarettes were at higher risk for colorectal neoplasia, according to study results.
Kimberley W.J. van der Sloot, MD, from the department of gastroenterology and hepatology at the University of Groningen in the Netherlands, wrote because of low use of screening, better methods are needed to help stratify individuals at higher risk for colorectal neoplasia (CRN).
“Cigarette smoking is associated with an increased risk of complications through increased inflammation in Crohn’s disease, while the opposite is seen in ulcerative colitis with a more benign course of established disease,” they wrote. “The role of cigarette smoking in development of CRN in patients with IBD is therefore of special interest, as cigarette smoke exposure has been associated with a long-term increased risk of CRN in the general population through its carcinogenic effect, causing irreversible genetic damage, induction of mutations and initiation of carcinogenesis.”
Researchers analyzed data from 1,386 patients with IBD who had previous biopsies analyzed and reported to a register and were screened for CRN. They evaluated clinical factors and stratified patients for guideline-based risk for CRN.
A total of 153 patients (11.5%) in the study developed CRN. Investigators observed that known risk factors, including first-degree relative with CRN in CD, presence of post-inflammatory polyps in UC, were replicated in their cohort.
Among patients with UC, former smoking increased risk for CRN (HR = 1.73; 95% CI, 1.05-2.85), while passive smoke exposure had no effect.
Among patients with CD, both active smoking (HR = 2.2; 95% CI, 1.02-4.76) and passive smoke exposure (HR = 1.87; 95% CI, 1.09-3.2) increased the risk for CRN.
“Based on the results in the current study, one could identify patients with CD, exposed to cigarette smoking, to be part of this high-risk group,” van der Sloot and colleagues wrote. “This hypothesis is supported by the finding that addition of cigarette smoke exposure to the currently used risk stratification for development of CRN might lead to further refinement of high- and low-risk groups.”
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