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Gu M, Wen M, Wu D, Xie T, Wang X. Independent associations of education, intelligence, and cognition with gastrointestinal diseases and the mediating effects of risk factors: a Mendelian randomization study. Front Med (Lausanne) 2024; 11:1342358. [PMID: 38410751 PMCID: PMC10894976 DOI: 10.3389/fmed.2024.1342358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/30/2024] [Indexed: 02/28/2024] Open
Abstract
Background Education, intelligence and cognition affect occupational performance and socioeconomic status and may influence virous diseases development. However, the impact of these factors on gastrointestinal diseases and their mediating risk factors remains unclear. Methods We utilized genome-wide association studies from European ancestry populations to perform two-sample Mendelian randomization analyses, aiming to estimate genetic instruments associated with education, intelligence, or cognition in relation to 24 gastrointestinal diseases Subsequently, we evaluated 14 potential mediators of this association and calculated the corresponding mediated proportions through two-step Mendelian randomization analyses. Result As the dominant factor in gastrointestinal diseases, education had a statistically significant association with 2 gastrointestinal diseases (acute pancreatitis, gastroesophageal reflux) and a suggestive association with 6 diseases (cirrhosis, alcoholic liver disease, cholecystitis, cholelithiasis, chronic gastritis and gastric ulcer). Of the 14 mediators, smoking and adiposity traits played a major role in mediating the effects. Conclusion The study demonstrated the causal, independent impact of education on specific gastrointestinal diseases. Smoking and adiposity traits emerged as primary mediators, illuminating potential avenues for targeted interventions for prevention of them.
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Affiliation(s)
| | | | | | | | - Xinxin Wang
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Navarro Correal E, Casellas Jorda F, Borruel Sainz N, Robles Alonso V, Herrera de Guise C, Ibarz Casas A, Sánchez García JM, Vila Morte G, Fuentelsaz Gallego C. Effectiveness of a Telephone-Based Motivational Intervention for Smoking Cessation in Patients With Crohn Disease: A Randomized, Open-Label, Controlled Clinical Trial. Gastroenterol Nurs 2021; 44:418-425. [PMID: 34269705 PMCID: PMC8635256 DOI: 10.1097/sga.0000000000000572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/14/2020] [Indexed: 11/29/2022] Open
Abstract
A randomized, open-label, controlled clinical trial was designed to assess the effectiveness of a motivational intervention based on the 5 R's model (relevance, risks, rewards, roadblocks, and repetition) delivered by specialized inflammatory bowel disease nurses every 3 months over a 1-year period as compared with patients who were followed regularly. Patients diagnosed with Crohn disease, aged 18 years or older, who reported being active smokers with Internet access at home and an e-mail address were eligible. A total of 144 patients (72 per group) were included (50% women, median age 40 years). They smoked a median of 10 cigarettes per day (range = 1-40) and had been smoking for a median of 22 years (range = 1-51). Motivation to quit (Richmond test) was low in 73 patients, moderate in 39 patients, and high in 32 patients. Statistically significant differences between the study groups in the predisposition to change, motivation to quit, and tobacco withdrawal were not found. However, 14 patients (20.9%) in the intervention group and 9 patients (13.2%) among controls stopped smoking at the end of the study. These findings support a higher trend toward smoking cessation associated with the motivational intervention 5 R's. This behavioral strategy can aid patients with Crohn disease to quit smoking.
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Affiliation(s)
- Ester Navarro Correal
- Correspondence to: Ester Navarro Correal, MSN, RN, Crohn-Colitis Care Unit Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain ()
| | - Francesc Casellas Jorda
- Ester Navarro Correal, MSN, RN, is a PhD student, Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain; and enrolled in PhD student program in Health at Universitat de Lleida
- Francesc Casellas Jorda, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Natalia Borruel Sainz, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Virginia Robles Alonso, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Claudia Herrera de Guise, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Arantxa Ibarz Casas, MSN, RN, is Research Nurse at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Josep Maria Sánchez García, MD, is Medicine Doctor at Service of Preventive Medicine and Epidemiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Genoveva Vila Morte, RN, is Nurse at Service of Preventive Medicine and Epidemiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Carmen Fuentelsaz Gallego, RN, PhD, is Research Nurse at Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Natalia Borruel Sainz
- Ester Navarro Correal, MSN, RN, is a PhD student, Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain; and enrolled in PhD student program in Health at Universitat de Lleida
- Francesc Casellas Jorda, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Natalia Borruel Sainz, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Virginia Robles Alonso, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Claudia Herrera de Guise, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Arantxa Ibarz Casas, MSN, RN, is Research Nurse at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Josep Maria Sánchez García, MD, is Medicine Doctor at Service of Preventive Medicine and Epidemiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Genoveva Vila Morte, RN, is Nurse at Service of Preventive Medicine and Epidemiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Carmen Fuentelsaz Gallego, RN, PhD, is Research Nurse at Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Virginia Robles Alonso
- Ester Navarro Correal, MSN, RN, is a PhD student, Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain; and enrolled in PhD student program in Health at Universitat de Lleida
- Francesc Casellas Jorda, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Natalia Borruel Sainz, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Virginia Robles Alonso, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Claudia Herrera de Guise, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Arantxa Ibarz Casas, MSN, RN, is Research Nurse at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Josep Maria Sánchez García, MD, is Medicine Doctor at Service of Preventive Medicine and Epidemiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Genoveva Vila Morte, RN, is Nurse at Service of Preventive Medicine and Epidemiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Carmen Fuentelsaz Gallego, RN, PhD, is Research Nurse at Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Claudia Herrera de Guise
- Ester Navarro Correal, MSN, RN, is a PhD student, Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain; and enrolled in PhD student program in Health at Universitat de Lleida
- Francesc Casellas Jorda, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Natalia Borruel Sainz, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Virginia Robles Alonso, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Claudia Herrera de Guise, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Arantxa Ibarz Casas, MSN, RN, is Research Nurse at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Josep Maria Sánchez García, MD, is Medicine Doctor at Service of Preventive Medicine and Epidemiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Genoveva Vila Morte, RN, is Nurse at Service of Preventive Medicine and Epidemiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Carmen Fuentelsaz Gallego, RN, PhD, is Research Nurse at Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Arantxa Ibarz Casas
- Ester Navarro Correal, MSN, RN, is a PhD student, Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain; and enrolled in PhD student program in Health at Universitat de Lleida
- Francesc Casellas Jorda, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Natalia Borruel Sainz, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Virginia Robles Alonso, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Claudia Herrera de Guise, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Arantxa Ibarz Casas, MSN, RN, is Research Nurse at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Josep Maria Sánchez García, MD, is Medicine Doctor at Service of Preventive Medicine and Epidemiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Genoveva Vila Morte, RN, is Nurse at Service of Preventive Medicine and Epidemiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Carmen Fuentelsaz Gallego, RN, PhD, is Research Nurse at Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Josep Maria Sánchez García
- Ester Navarro Correal, MSN, RN, is a PhD student, Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain; and enrolled in PhD student program in Health at Universitat de Lleida
- Francesc Casellas Jorda, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Natalia Borruel Sainz, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Virginia Robles Alonso, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Claudia Herrera de Guise, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Arantxa Ibarz Casas, MSN, RN, is Research Nurse at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Josep Maria Sánchez García, MD, is Medicine Doctor at Service of Preventive Medicine and Epidemiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Genoveva Vila Morte, RN, is Nurse at Service of Preventive Medicine and Epidemiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Carmen Fuentelsaz Gallego, RN, PhD, is Research Nurse at Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Genoveva Vila Morte
- Ester Navarro Correal, MSN, RN, is a PhD student, Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain; and enrolled in PhD student program in Health at Universitat de Lleida
- Francesc Casellas Jorda, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Natalia Borruel Sainz, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Virginia Robles Alonso, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Claudia Herrera de Guise, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Arantxa Ibarz Casas, MSN, RN, is Research Nurse at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Josep Maria Sánchez García, MD, is Medicine Doctor at Service of Preventive Medicine and Epidemiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Genoveva Vila Morte, RN, is Nurse at Service of Preventive Medicine and Epidemiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Carmen Fuentelsaz Gallego, RN, PhD, is Research Nurse at Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Carmen Fuentelsaz Gallego
- Ester Navarro Correal, MSN, RN, is a PhD student, Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain; and enrolled in PhD student program in Health at Universitat de Lleida
- Francesc Casellas Jorda, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Natalia Borruel Sainz, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Virginia Robles Alonso, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Claudia Herrera de Guise, MD, PhD, is Gastroenterologist at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Arantxa Ibarz Casas, MSN, RN, is Research Nurse at Crohn-Colitis Care Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Josep Maria Sánchez García, MD, is Medicine Doctor at Service of Preventive Medicine and Epidemiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Genoveva Vila Morte, RN, is Nurse at Service of Preventive Medicine and Epidemiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Carmen Fuentelsaz Gallego, RN, PhD, is Research Nurse at Vall d'Hebron Hospital Universitari, Barcelona, Spain
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Syal G, Serrano M, Jain A, Cohen BL, Rieder F, Stone C, Abraham B, Hudesman D, Malter L, McCabe R, Holubar S, Afzali A, Cheifetz AS, Gaidos JKJ, Moss AC. Health Maintenance Consensus for Adults With Inflammatory Bowel Disease. Inflamm Bowel Dis 2021; 27:1552-1563. [PMID: 34279600 PMCID: PMC8861367 DOI: 10.1093/ibd/izab155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND With the management of inflammatory bowel disease (IBD) becoming increasingly complex, incorporating preventive care health maintenance measures can be challenging. The aim of developing these updated recommendations is to provide more specific details to facilitate their use into a busy clinical practice setting. METHOD Fifteen statements were formulated with recommendations regarding the target, timing, and frequency of the health maintenance interventions in patients with IBD. We used a modified Delphi method and a literature review to establish a consensus among the panel of experts. The appropriateness of each health maintenance statement was rated on a scale of 1 to 5 (1-2 as inappropriate, and 4-5 as appropriate) by each panelist. Interventions were considered appropriate, and statements were accepted if ≥80% of the panelists agreed with a score ≥4. RESULTS The panel approved 15 health maintenance recommendations for adults with IBD based on the current literature and expert opinion. These recommendations include explicit details regarding specific screening tools, timing of screening, and vaccinations for adults with IBD. CONCLUSIONS Patients with IBD are at an increased risk for infections, malignancies, and other comorbidities. Given the complexity of caring for patients with IBD, this focused list of recommendations can be easily incorporated in to clinical care to help eliminate the gap in preventative care for patients with IBD.
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Affiliation(s)
- Gaurav Syal
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Animesh Jain
- University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | | - Christian Stone
- Comprehensive Digestive Institute of Nevada, Las Vegas, Nevada, USA
| | | | - David Hudesman
- New York University Langone Medical Center, New York, New York, USA
| | - Lisa Malter
- NYU Grossman School of Medicine, Bellevue Hospital Center, New York, New York, USA
| | | | | | - Anita Afzali
- Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Adam S Cheifetz
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Alan C Moss
- Boston University School of Medicine, Boston, Massachusetts, USA,Address correspondence to: Alan C. Moss, MD, MBBCh, BAO, Professor, Boston University School of Medicine, 830 Harrison Avenue, 2nd floor, Boston, MA, 02118, USA. E-mail:
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Tse SS, Sands BE, Keefer L, Cohen BL, Maser E, Ungaro RC, Marion JF, Colombel JF, Itzkowitz SH, Gelman J, Dubinsky MC. Improved Smoking Cessation Rates in a Pharmacist-Led Program Embedded in an Inflammatory Bowel Disease Specialty Medical Home. J Pharm Pract 2021; 35:827-835. [PMID: 33827316 DOI: 10.1177/08971900211000682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cigarette smoking is associated with disease progression, poor outcomes, and increased biologic use in Crohn's Disease (CD). In this prospective study, we describe the structure and results of a pharmacist-driven smoking cessation program in an Inflammatory Bowel Disease (IBD) Specialty Medical Home. METHODS One pharmacist designed and implemented a collaborative drug therapy management (CDTM) program, which allowed the pharmacist to initiate and modify smoking cessation aids, monitor medication safety and efficacy, and provide behavioral counseling. Crohn's Disease patients who were current smokers and referred to the program were analyzed. Clinical and demographic data, disease activity, and smoking history were collected. The primary outcome was the proportion of patients in the enrolled group and the declined group who quit smoking at least once during the follow-up period. Secondary outcomes include demographic and clinical differences between enrolled and declined patients, and enrolled quitters and non-quitters. RESULTS Thirty-two patients were referred to the program and 19 participated. Over a median follow-up period of 305 [264-499] days, 42% (8/19) of enrolled patients quit smoking at least once. Fifteen percent (2/13) of declined patients quit smoking. Patients who continued to smoke had more instances of loss of response to a biologic, need to start a new biologic, or escalation of biologic therapy. The CDTM pharmacist was able to provide all necessary clinical services for smokers enrolled in the program. CONCLUSIONS A pharmacist-led smoking cessation program in a specialty medical home is feasible. It may result in successful quit attempts and may optimize IBD medication use.
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Scoville EA, Tindle HA, Wells QS, Peyton SC, Gurwara S, Pointer SO, Horst SN, Schwartz DA, Adams DW, Freiberg MS, Gatskie V, King S, Abney LR, Beaulieu DB. Precision nicotine metabolism-informed care for smoking cessation in Crohn's disease: A pilot study. PLoS One 2020; 15:e0230656. [PMID: 32214373 PMCID: PMC7098646 DOI: 10.1371/journal.pone.0230656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/04/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Smoking is a strong risk factor for disease severity in Crohn's disease (CD) and cessation improves outcomes. The nicotine metabolite ratio (NMR) predicts cessation success with pharmacotherapy: varenicline doubles cessation over nicotine replacement therapy (NRT) for "normal", but not "slow" metabolizers. Varenicline side effects are heightened in slow metabolizers. Methods using NMR to optimize cessation pharmacotherapy have not been evaluated in CD. AIMS We aim to determine the prevalence of smoking in a CD population and then assess these smokers' attitudes toward a personalized metabolism-informed care (MIC) approach to cessation. METHODS In this observational study, we surveyed 1098 patients visiting an inflammatory bowel disease center about their smoking history. We then evaluated a subgroup of individuals with CD (n = 32) who participated in a randomized controlled trial of smoking cessation using MIC versus usual care. For MIC, medication selection was informed by the NMR (normal ≥0.31 vs. slow <0.31). The primary outcomes were intervention satisfaction and match rates between NMR and medication choice. RESULTS The baseline prevalence of smoking in our CD population was 13%. Intervention participants reported high rates of satisfaction (85%) and chose a medication that matched their NMR result more often in the MIC group (100% vs. 64%, p = 0.01). Six of 16 (37.5%) patients prescribed varenicline discontinued due to side effects. CONCLUSION MIC produced high rates of satisfaction and matching between NMR and medication in CD patients, supporting patient acceptance and feasibility of precision smoking cessation in this population. To reduce smoking in CD, therapies such as MIC are needed to maximize efficacy and minimize side effects.
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Affiliation(s)
- Elizabeth A. Scoville
- Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- * E-mail:
| | - Hilary A. Tindle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, United States of America
| | - Quinn S. Wells
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Shannon C. Peyton
- Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Shelly Gurwara
- Division of Gastroenterology, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Stephanie O. Pointer
- Division of Gastroenterology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Sara N. Horst
- Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - David A. Schwartz
- Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Dawn W. Adams
- Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Matthew S. Freiberg
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, United States of America
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Vanessa Gatskie
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Stephen King
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Lesa R. Abney
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Dawn B. Beaulieu
- Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
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Nulsen B, Sands BE, Shah BJ, Ungaro RC. Practices, attitudes, and knowledge about Crohn's disease and smoking cessation among gastroenterologists. Eur J Gastroenterol Hepatol 2018; 30:155-60. [PMID: 29240002 DOI: 10.1097/MEG.0000000000001010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Cigarette smoking is one of the most important, modifiable environmental factors in Crohn's disease (CD) and screening for tobacco use is an official recommendation and quality measure in the care of CD patients. The objective of this study was to learn more about gastroenterologists' practices, opinions, and knowledge in this area. PATIENTS AND METHODS A 15 question survey was sent through email to two national gastroenterology distribution lists. Questions were written in multiple choice formats and were designed to collect information about gastroenterologists' practices, attitudes, and knowledge regarding smoking cessation in CD patients. Responses were stratified by practice setting, experience, and inflammatory bowel disease-focus. Responses were anonymous and were collected in a secure, online database. RESULTS A total of 141 respondents completed the survey. Overall, 89% of participants screened their CD patients for smoking more than 75% of the time. In all, 62% provided smoking cessation counseling more than 75% of the time. Overall, 94% of respondents felt comfortable discussing the benefits of smoking cessation with their patients. In all, 56% felt comfortable discussing smoking cessation strategies with their patients. Overall, 88% of respondents agreed that gastroenterologists should provide smoking cessation counseling; however, 43 and 11% agreed that the gastroenterologist should be the primary counselor and primary prescriber of cessation-related pharmacotherapy, respectively. CONCLUSION Surveyed gastroenterologists agree that smoking cessation is an important part of the care of CD patients and this is reflected in their screening practices. Counseling occurs irregularly and many gastroenterologists do not feel comfortable discussing cessation strategies. Future guidelines should provide further guidance on the gastroenterologist's role in smoking cessation counseling for CD patients.
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Song EM, Kim GU, Seo M, Hwang SW, Park SH, Kwon E, Lee HS, Yang DH, Kim KJ, Ye BD, Byeon JS, Myung SJ, Yang SK. Assessment of factors associated with smoking cessation at diagnosis or during follow-up of Crohn's disease. J Gastroenterol Hepatol 2018; 33:180-186. [PMID: 28556205 DOI: 10.1111/jgh.13833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/14/2017] [Accepted: 05/18/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM Smoking cessation is known to improve the course of Crohn's disease (CD). However, the factors associated with smoking cessation after CD diagnosis have not been well established. METHODS Clinical characteristics and change in smoking status were evaluated in 445 current smokers at the time of CD diagnosis. Patients were classified into three subgroups based on their final smoking status and time of smoking cessation: non-quitters, quitters at diagnosis, and quitters during follow-up. RESULTS The overall smoking cessation rate was 55.7% (248 of 445 patients). The diagnosis of CD was the main reason for quitting (41.5%, 103 of 248 patients). Smoking cessation at the time of CD diagnosis was associated with intestinal resection within 3 months from CD diagnosis (odds ratio [OR] 2.355, 95% confidence interval [CI] 1.348-4.116, P = 0.003), light smoking (OR 2.041, 95% CI 1.157-3.602, P = 0.014), and initiation of smoking before 18 years of age (OR 0.570, 95% CI 0.327-0.994, P = 0.047). Light smoking (OR 1.762, 95% CI 1.019-3.144, P = 0.043) and initiation of smoking before 18 years (OR 0.588, 95% CI 0.381-0.908, P = 0.017) were also associated with overall smoking cessation. CONCLUSION Quitters after CD diagnosis, including quitters at diagnosis and quitters during follow-up, had features distinct from those of non-quitters. Given the motivation at CD diagnosis, a detailed history of smoking habits should be taken and all current smokers should be encouraged to quit smoking at the time of CD diagnosis.
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Affiliation(s)
- Eun Mi Song
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Gwang-Un Kim
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Myeongsook Seo
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sung Wook Hwang
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sang Hyoung Park
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Eunja Kwon
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ho-Su Lee
- Department of Health Screening and Promotion Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyung-Jo Kim
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Byong Duk Ye
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Gklavas A, Dellaportas D, Papaconstantinou I. Risk factors for postoperative recurrence of Crohn's disease with emphasis on surgical predictors. Ann Gastroenterol 2017; 30:598-612. [PMID: 29118554 PMCID: PMC5670279 DOI: 10.20524/aog.2017.0195] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/10/2017] [Indexed: 12/12/2022] Open
Abstract
Intestinal resection for Crohn’s disease is not curative and postoperative recurrence rates remain high. Early detection of indices associated with recurrence and risk stratification are fundamental for the postoperative management of patients. Early endoscopy at 6-12 months is the “gold standard” procedure, whereas other modalities such as fecal calprotectin and imaging techniques can contribute to the diagnosis of recurrence. The purpose of this review is to summarize current data regarding risk factors correlated with postoperative relapse. Smoking is a well-established, modifiable risk factor. There are sufficient data that correlate penetrating disease, perianal involvement, extensive resections, prior surgery, histological features (plexitis and granulomas), and improper management after resection with high rates for recurrence. The literature provides conflicting data for other possible predictors, such as age, sex, family history of inflammatory bowel disease, location of disease, strictureplasties, blood transfusions, and postoperative complications, necessitating further evidence. On the other hand, surgical factors such as anastomotic configuration, open or laparoscopic approach, and microscopic disease at specimen margins when macroscopic disease is resected, seem not to be related with an increased risk of recurrence. Further recognition of histological features as well as gene-related factors are promising fields for research.
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Affiliation(s)
- Antonios Gklavas
- 2 Department of Surgery, Aretaieion University Hospital, University of Athens, School of Medicine, Athens, Greece
| | - Dionysios Dellaportas
- 2 Department of Surgery, Aretaieion University Hospital, University of Athens, School of Medicine, Athens, Greece
| | - Ioannis Papaconstantinou
- 2 Department of Surgery, Aretaieion University Hospital, University of Athens, School of Medicine, Athens, Greece
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10
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Nunes T, Etchevers MJ, García-Sánchez V, Ginard D, Martí E, Barreiro-de Acosta M, Gomollón F, Arroyo M, Bastida G, Gonzalez B, Monfort D, García-Planella E, Figueroa C, Panés J, Sans M. Impact of Smoking Cessation on the Clinical Course of Crohn's Disease Under Current Therapeutic Algorithms: A Multicenter Prospective Study. Am J Gastroenterol 2016; 111:411-9. [PMID: 26856753 DOI: 10.1038/ajg.2015.401] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 10/03/2015] [Accepted: 11/01/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Given the importance of tobacco smoking (TS) as the only environmental factor repeatedly linked to the development of the Crohn's disease (CD), it is surprising that very few prospective studies have assessed whether TS is associated with an increased frequency of clinical relapse. Our aim was to evaluate the current impact of TS on disease relapse and the clinical benefit of quitting smoking in the present era of widespread use of anti-TNF drugs and immunosuppressants. METHODS This was a multicenter prospective cohort study, which included 573 CD patients in clinical remission with various smoking habits. All smokers were advised to quit. Patients not exposed to tobacco before inclusion (non- and former smokers), continuing smokers, and quitters were compared regarding differences in disease outcomes during a follow-up of 4 years. RESULTS A total of 148 continuing smokers, 190 nonsmokers, 160 former smokers, and 75 quitters were included. In comparison with nonsmokers, continuing smokers relapsed more frequently with an incidence rate ratio of 1.53 (95% confidence interval (CI): 1.10-2.17). Former smokers and quitters had similar relapse incidences compared with nonsmokers. Smoking was an independent predictor for disease relapse in the multivariate analysis (hazard ratio: 1.58 (95% CI 1.20-2.09). In the time-dependent analysis, continuing smokers had earlier relapse, regardless of anti-TNF or immunosuppressant use. CONCLUSIONS Continuing smokers have more disease relapses, and patients who quit smoking have a similar relapse incidence compared with nonsmokers.
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Affiliation(s)
- Tiago Nunes
- Hospital Clinic Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | | | | | - Daniel Ginard
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Eva Martí
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | | | | | | | | | | | | | | | - Julián Panés
- Hospital Clinic Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Miquel Sans
- Hospital Clinic Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
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11
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Abstract
The TABACROHN Study Group conducted a multicenter prospective cohort study, demonstrating that smoking cessation improved the prognosis of Crohn's disease. Patients who continued to smoke were 50% more likely to relapse compared with non-smokers. Smoking cessation reduced the risk of flaring, regardless of exposure to anti-tumor necrosis factor agents. Despite the evidence that smoking cessation is beneficial, many patients do not quit smoking after their diagnosis of Crohn's disease. Lack of awareness, physical addiction, and social context of smoking inhibit smoking cessation. In spite of this, comprehensive smoking cessation programs have been shown to be effective and reduce costs.
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12
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To N, Gracie DJ, Ford AC. Systematic review with meta-analysis: the adverse effects of tobacco smoking on the natural history of Crohn's disease. Aliment Pharmacol Ther 2016; 43:549-61. [PMID: 26749371 DOI: 10.1111/apt.13511] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 12/05/2015] [Accepted: 12/09/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tobacco smoking is a well-established risk factor for the development of Crohn's disease, and this may lead to a more complicated disease course. However, recent evidence suggests that many patients with Crohn's disease are unaware of this fact. AIM To perform a systematic review and meta-analysis of the effects of smoking on disease course in Crohn's disease. METHODS A search of MEDLINE, EMBASE and EMBASE classic was carried out (up to July 2015) to identify observational studies reporting data on smoking and rates of surgery or flares of disease activity in patients with Crohn's disease. Dichotomous data were pooled to obtain odds ratios (ORs) for flares of disease activity or need for surgery, with 95% confidence intervals (CIs). RESULTS The search identified 33 eligible studies. Compared with nonsmokers, smokers had increased odds of flare of disease activity (OR, 1.56; 95% CI, 1.21-2.01), flare after surgery (OR, 1.97; 95% CI, 1.36-2.85), need for first surgery (OR, 1.68; 95% CI, 1.33-2.12) and need for second surgery (OR, 2.17; 95% CI, 1.63-2.89). The odds of these outcomes among ex-smokers diminished upon smoking cessation, with ORs comparable to those among nonsmokers and, in the case of flare or second surgery, significantly lower than smokers. CONCLUSIONS Smokers with Crohn's disease have a more complicated disease course than nonsmokers, and quitting smoking may ameliorate this. Patients should be reminded of the detrimental effects of smoking on the course of their disease, and smoking cessation advice should be provided to reduce disease burden and costs in these patients.
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Affiliation(s)
- N To
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - D J Gracie
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - A C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
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13
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De Bie C, Ballet V, Hendriks N, Coenen S, Weyts E, Van Assche G, Vermeire S, Ferrante M. Smoking behaviour and knowledge of the health effects of smoking in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2015; 42:1294-302. [PMID: 26435040 DOI: 10.1111/apt.13423] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 08/20/2015] [Accepted: 09/14/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND The detrimental effect of smoking on development and progression of Crohn's disease (CD) is generally accepted. AIM To evaluate the awareness of smoking risks in a Belgian inflammatory bowel disease (IBD) population. METHODS In the out-patient clinic of a tertiary referral centre, 625 consecutive patients with CD, 238 patients with ulcerative colitis (UC) and 289 non-IBD controls, filled out a simple questionnaire. This questionnaire included data on smoking behaviour and awareness of smoking-related health effects, including effects on IBD. RESULTS At diagnosis, more CD patients were active smokers compared to UC (40% vs. 17%, P < 0.001). Remarkably, smoking cessation rates after diagnosis were similar for CD and UC (both 56%, P = 0.997). The great majority recognised a detrimental influence of smoking on general health (98-99%), lung cancer (95-97%), myocardial infarction (89-92%) and stroke (78-87%). Although CD patients more frequently acknowledged risks of smoking on their disease, only 37% were aware of a link with CD development, 30% of increased surgical rates and 27% of increased post-operative CD recurrence. Active smokers more frequently denied an increased risk of surgery and higher post-operative CD recurrence. Intriguingly, within the active smokers with CD, those not willing to quit smoking most often denied a potential bad influence of smoking. Taking into account disease duration, previous surgery, education level, working status and nicotine dependence, we were unable to define specific subgroups of patients requiring extra education. CONCLUSION Although patients with Crohn's disease were better informed on the detrimental effects of smoking, the awareness rate was still low.
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Affiliation(s)
- C De Bie
- Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - V Ballet
- Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - N Hendriks
- Department of Clinical and Experimental Medicine, Translational Research Centre for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - S Coenen
- Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Department of Clinical and Experimental Medicine, Translational Research Centre for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - E Weyts
- Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - G Van Assche
- Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Department of Clinical and Experimental Medicine, Translational Research Centre for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - S Vermeire
- Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Department of Clinical and Experimental Medicine, Translational Research Centre for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - M Ferrante
- Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Department of Clinical and Experimental Medicine, Translational Research Centre for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
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14
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Zuo L, Li Y, Wang H, Wu R, Zhu W, Zhang W, Cao L, Gu L, Gong J, Li N, Li J. Cigarette smoking is associated with intestinal barrier dysfunction in the small intestine but not in the large intestine of mice. J Crohns Colitis 2014; 8:1710-22. [PMID: 25205553 DOI: 10.1016/j.crohns.2014.08.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 07/23/2014] [Accepted: 08/15/2014] [Indexed: 02/07/2023]
Abstract
AIMS To observe the effect of cigarette smoke (CS) on the small bowel and colon in mice and to attempt to explain the potential mechanisms that account for these effects. METHODS Male BALB/c mice age 6-8 weeks were randomly divided into a CS group and a control group (n=10 per group). CS mice were exposed to CS (five cigarettes each time, four times a day for 5 days a week using Hamburg II smoking machine and CS was diluted with air at a ratio of 1:6) for 10 weeks, and control mice were exposed to room air. After 10 weeks, mice were sacrificed for analysis (colon and small bowel). RESULTS CS exposure impaired the intestinal barrier of the small bowel, based on evidence that CS mice exhibited increased intestinal permeability, bacterial translocation, intestinal villi atrophy, damaged tight junctions and abnormal tight junction proteins. These changes were partly mediated through the activated NF-κB (p65) signalling pathway. However, no obvious changes associated with the intestinal barrier were identified in the small bowel of control mice or the colons of control or CS mice. CONCLUSIONS CS is associated with intestinal barrier dysfunction in the small intestine but not in the large intestine of mice.
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Affiliation(s)
- Lugen Zuo
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yi Li
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Honggang Wang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Rong Wu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Weiming Zhu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
| | - Wei Zhang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Lei Cao
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Lili Gu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jianfeng Gong
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ning Li
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jieshou Li
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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15
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Jones GR, Kennedy NA, Lees CW, Arnott ID, Satsangi J. Systematic review: The use of thiopurines or anti-TNF in post-operative Crohn's disease maintenance--progress and prospects. Aliment Pharmacol Ther 2014; 39:1253-65. [PMID: 24738574 DOI: 10.1111/apt.12743] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 12/23/2013] [Accepted: 03/20/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Post-operative recurrence of Crohn's disease is an important management challenge, with 2-year recurrence rates defined by clinical, endoscopic and radiological parameters of up to 77%, 64% and 49%. Clinical and severe endoscopic recurrence vary widely in controlled trials from 13% to 36% and 22% to 56% with thiopurine treatment or 0% and 9% with infliximab treatment respectively at 1 year. AIMS To provide a review of the evidence for thiopurine or anti-TNF use in post-operative Crohn's disease, and to assess the ability to identify those patients at highest risk of recurrent disease. METHODS A literature search was undertaken using Medline, Embase and Cochrane databases to identify studies using search terms 'thiopurine', 'azathioprine', 'mercaptopurine', 'Infliximab', 'adalimumab', 'Anti-TNF', 'Crohn's disease', 'post-operative' and 'recurrence'. RESULTS Trials to examine this important area have proved difficult to execute, with recruitment and retention of patients posing major challenges to randomised clinical trials. There have been four RCTs of 433 patients of thiopurine therapy (with three meta-analyses of these data), and one of anti-TNF therapy involving 24 patients. Overall the efficacy data for thiopurine use in this setting are inconclusive, and other than smoking, there are no consistent predictors of post-operative relapse. CONCLUSIONS At present, evidence for routine use of thiopurine treatment in post-operative Crohn's disease is heterogeneous and unconvincing. Stratification by risk of relapse emerges as a key challenge in post-operative management that needs to be addressed, using clinical parameters and emerging biomarkers. The evidence for prophylactic anti-TNF use is limited though promising, with its routine use guided by early assessment of relapse.
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Affiliation(s)
- G R Jones
- Department of Gastroenterology, Western General Hospital, Edinburgh, UK
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