title: Early azathioprine/biological therapy is associated with decreased risk for first surgery and delays time to surgery but not reoperation in both smokers and nonsmokers with Crohn's disease, while smoking decreases the risk of colectomy in ulcerative colitis.
abstract: OBJECTIVE
  Smoking may alter the natural course of Crohn's disease (CD). Smokers are more likely to develop complications, relapses and have a greater risk for surgery. In contrast, in ulcerative colitis (UC), smoking might improve the disease course. Our aim was to assess the combined effect of disease phenotype, smoking, and immunomodulator [azathioprine (AZA), AZA/biological] treatment on the risk of intestinal resection/reoperation in CD and colectomy in UC.
  
  
  METHODS
  Six hundred and eighty-one inflammatory bowel disease patients were analyzed (CD: 340, male/female: 155/185, duration: 9.4+/-7.5 years; UC: 341, male/female: 174/164, duration: 11.5+/-9.7 years). Patients were interviewed on their smoking habits at the time of diagnosis and during the regular follow-up visits. Medical records were retrospectively analyzed.
  
  
  RESULTS
  Smoking was present in 45.5% in CD and 15.8% in UC. CD patients who underwent at least one bowel resection comprised 46.5%. In an univariate analysis, disease location, behavior, AZA, or AZA/biological use before surgery [odds ratio (OR): 0.26 and 0.22, P<0.001] and smoking (OR: 1.61, P = 0.03) were associated with risk for first surgery. Smoking, AZA, or AZA/biological (P<0.001) use before first surgery and disease behavior were independently associated with risk for surgery in a proportional Cox-regression analysis. Perianal disease (OR: 3.2, P = 0.001) and frequent relapses (OR: 4.8, P<0.001) but not smoking, AZA, or AZA/biological use after first surgery were predictive for reoperation. In UC, the rate of colectomy was 5.6%. Disease location (P = 0.001) and smoking status (P = 0.02) were independently associated with risk for colectomy in a proportional Cox-regression analysis.
  
  
  CONCLUSIONS
  Our data suggest that early AZA/biological therapy reduces the risk for first operation but not reoperation in CD, in both smokers and nonsmokers. In contrast, smoking was associated with a decreased need for colectomy in UC.
authors: Department of Gastroenterology, State Health Centre, Budapest, Hungary.
authors: Tamas
authors: T
authors: Szamosi
authors: Janos
authors: J
authors: Banai
authors: Laszlo
authors: L
authors: Lakatos
authors: Zsofia
authors: Z
authors: Czegledi
authors: Gyula
authors: G
authors: David
authors: Ferenc
authors: F
authors: Zsigmond
authors: Tunde
authors: T
authors: Pandur
authors: Zsuzsanna
authors: Z
authors: Erdelyi
authors: Orsolya
authors: O
authors: Gemela
authors: Maria
authors: M
authors: Papp
authors: Janos
authors: J
authors: Papp
authors: Peter Laszlo
authors: PL
authors: Lakatos
mesh_terms: D000293:Adolescent; D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use*; D001691:Biological Therapy; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery; D003424:Crohn Disease / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007155:Immunologic Factors; D001379:Azathioprine