title: Tobacco use is associated with accelerated clinical recurrence of Crohn's disease after surgically induced remission.
abstract: OBJECTIVE
  To study the association between tobacco exposure and postoperative clinical recurrence in Crohn's disease patients and quantify the time to clinical relapse following surgical resection.
  
  
  BACKGROUND
  It is well accepted that cigarette smoking has a negative impact on postoperative course in Crohn's disease. However, the effect of smoking to hasten clinical recurrence has not been clearly delineated.
  
  
  METHODS
  We reviewed medical records of patients undergoing surgical resection for medication-refractory disease within a 5-year period. Patients were followed for a period of 250 weeks. Outcomes were compared between smokers and nonsmokers and stratified by gender.
  
  
  RESULTS
  Fifty-nine patients were studied. Sixty-nine percent of smokers versus 23% of nonsmokers had recurrent symptoms (P = 0.02) by the end of the observation period. There was no difference in the mean ages, gender, disease location, use of postoperative medications, or number of postoperative visits (P > 0.09). Smoking was associated with an increased risk of clinical recurrence [odds ratio 2.96 (95% confidence interval, CI 1.5-5.6)]. The time to clinical relapse for smokers was 130 weeks versus 234 weeks in nonsmokers (P < 0.001).
  
  
  CONCLUSIONS
  Smoking is associated with clinical recurrence of Crohn's disease, and the time to clinical recurrence in smokers is shorter. Strategies for smoking cessation are warranted.
authors.affiliation: University of Chicago, Chicago IL 60637, USA. skane@medicine.bsd.uchicago.edu
authors.forename: Sunanda V
authors.initials: SV
authors.lastname: Kane
authors.forename: Michael
authors.initials: M
authors.lastname: Flicker
authors.forename: Flora
authors.initials: F
authors.lastname: Katz-Nelson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003424:Crohn Disease / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012907:Smoking / Q000009:adverse effects*; D013997:Time Factors