Clinical status of ulcerative colitis in patients who smoke.
OBJECTIVE
Ulcerative colitis (UC) is largely a disease of nonsmokers. There are few patients who are current smokers, but we have identified a group and reviewed their clinical status, disease activity, and nicotine exposure to examine whether they remain well controlled while smoking.


METHODS
Fifty-one patients from three centers with verified UC were reviewed.


RESULTS
Thirty of the group were men; mean age 50 yr, with a mean age of onset of 37 yr. Twenty-two patients had proctosigmoid disease, 12 involvement of left colon, and 17 total colitis. All were current smokers; 41 were cigarette smokers averaging 17 daily. At the onset of colitis 30 were nonsmokers, 25 of them were ex-smokers and 19 developed colitis within 2 yr of stopping smoking. Twenty-eight believed smoking improved disease activity and none felt smoking had a detrimental effect on their UC. Eleven were receiving no medication for UC, 40 were receiving 5-ASA (5-aminosalicylic acid) preparations, and only two took oral steroids. All were in clinical remission, with the exception of one patient; mean St. Marks score was 1.5, out of a possible total of 22. Sigmoidoscopic grades were inactive in all patients except three. Histological assessment showed significant activity in only five. Median serum nicotine was 8 ng/ml (range, 0.4-24.4), median serum cotinine 180 ng/ml (range, 20-453), with corresponding salivary cotinine of 255 ng/ml (range, 34-683). Median rise in nicotine 2 min after a cigarette in 35 patients was 12.1 ng/ml (range, 0.4-44).


CONCLUSIONS
Because most current smokers with UC have inactive disease, smoking may contribute to the clinical remission in these patients.
Green
J T
JT
Department of Gastroenterology, University Hospital of Wales, Cardiff, UK.
Rhodes
J
J
Ragunath
K
K
Thomas
G A
GA
Williams
G T
GT
Mani
V
V
Feyerabend
C
C
Russell
M A
MA
D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000097:blood; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012812:Sigmoidoscopy; D012907:Smoking / Q000009:adverse effects* / Q000097:blood; D016540:Smoking Cessation; D006113:United Kingdom
D009538:Nicotine