Gender differences in the response of colitis to smoking.
OBJECTIVE
The aim of this study was to examine in parallel the effect of smoking on ulcerative colitis and Crohn's colitis and assess the effect of gender on the response of colitis to smoking.


METHODS
Medical charts of 1784 adult consecutive patients (978 patients, ulcerative colitis; 118 patients, indeterminate colitis; and 688 patients, Crohn's colitis), whose smoking habits were specified by direct interview, were reviewed.


RESULTS
The proportion of ever smokers was 42% in ulcerative colitis, 43% in indeterminate colitis, and 61% in Crohn's colitis. Smoking cessation preceded the onset of colitis in 279 patients with ulcerative colitis or indeterminate colitis (61%) and only 52 patients (12%) with Crohn's colitis. In ulcerative colitis and indeterminate colitis, current smoking delayed mean age at disease onset in men (from 32 to 41 yr; P < 0.001), but not women (from 33 to 33 yr), and decreased the need for immunosuppressants in men (10-yr cumulative risk, 26% +/- 4% in nonsmokers vs. 8% +/- 4% in smokers; P < 0.01), but not significantly in women. Conversely, in Crohn's colitis, current smoking hastened disease onset in women (from 35 to 29 yr; P < 0.001), but not men (from 32 to 31 yr), and increased the need for immunosuppressants in women (10-yr cumulative risk, 48% +/- 5% in nonsmokers vs. 58% +/- 4% in smokers; P < 0.01), but not men.


CONCLUSIONS
The dual effects of smoking in colitis, beneficial in ulcerative colitis and harmful in Crohn's colitis, are modulated importantly by gender, with women having more disadvantage than men.
Cosnes
Jacques
J
Hôpital Saint-Antoine, 184 rue du Faubourg St-Antoine, 75571 Paris cedex 12, France. jacques.cosnes@sat.ap-hop-paris.fr
Nion-Larmurier
Isabelle
I
Afchain
Pauline
P
Beaugerie
Laurent
L
Gendre
Jean-Pierre
JP
D000328:Adult; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D003270:Contraceptive Agents / Q000008:administration & dosage; D003424:Crohn Disease / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation; D013223:Statistics as Topic; D013997:Time Factors; D016896:Treatment Outcome
D003270:Contraceptive Agents; D007166:Immunosuppressive Agents