title: Low-dose smoking resumption in ex-smokers with refractory ulcerative colitis.
abstract: OBJECTIVE
  Ulcerative colitis (UC) is primarily a disease of non-smokers. Ex-smokers may have a more refractory disease course and anecdotal evidence in non-controlled clinical trials have suggested that smoking resumption, or the administration of nicotine, may ameliorate signs and symptoms of UC in ex-smokers. We report outcomes of ex-smokers with refractory UC who resumed low-dose cigarette smoking.
  
  
  METHODS
  17 ex-smokers with refractory UC were identified. Clinical remission was defined as a disease activity index score of 0.
  
  
  RESULTS
  Two out of 17 patients refused the recommendation to resume smoking. Of the 15 patients who resumed smoking, the mean daily number of cigarettes was 8.6. Fourteen out of those 15 patients who resumed smoking were able to maintain prolonged clinical remission off steroids. One out of the 15 patients failed to improve and required oral steroids. Another patient was compelled to quit smoking since he became addicted. His disease flared after maintaining a prolonged remission of 3 years and he eventually underwent surgery. Three out of these 15 patients switched from cigarettes smoking to nicotine compounds and continued to maintain remission.
  
  
  CONCLUSIONS
  Resumption of low dose smoking in a selected group of ex-smokers with refractory UC may ameliorate signs and symptoms. Quality of life, medication side effects, and smoking risk factors should all be considered and discussed with patients. Smokers should be meticulously followed for compliance with "low-dose" regimen and all associated smoking risks.
authors.affiliation: Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, IL 60637, USA. emmac@libero.it
authors.forename: Emma
authors.initials: E
authors.lastname: Calabrese
authors.forename: Henit
authors.initials: H
authors.lastname: Yanai
authors.forename: Dmitry
authors.initials: D
authors.lastname: Shuster
authors.forename: David T
authors.initials: DT
authors.lastname: Rubin
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Hanauer
mesh_terms: D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D005260:Female; D006801:Humans; D060046:Maintenance Chemotherapy; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage / Q000627:therapeutic use*; D018722:Nicotinic Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D012720:Severity of Illness Index; D012907:Smoking; D061485:Tobacco Use Cessation Devices
chemical_list: D018722:Nicotinic Agonists; D009538:Nicotine