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American Journal of Epidemiology Vol. 125, No. 3: 445-452
Copyright © 1987 by The Johns Hopkins University School of Hygiene and Public Health

research-article

NONSPECIFIC INFLAMMATORY BOWEL DISEASE AND SMOKING

SILVIA FRANCESCHI1, ELISA PANZA2, CARLO LA VECCHIA3, FABIO PARAZZINI2, ADRIANO DECARLI4 and GABRIELE BIANCHI PORRO2

1Centro di Riferimento Oncologico Via Pedemontana Occ., 33081 Aviano (PN), Italy
2Ospedale Generate Provinciale "L Sacco," Via G.B. Grassi, 74–20157 Milan Italy
3Istituto di Ricerche Farmacologiche "Mario Negri," Via Eritrea, 62–20157 Milan Italy
4Istituto di Biometria-Universit{acute} di Milano and Istituto per lo Studio e la Curs dei Tumori, Via Venezian, 1–20133 Milan Italy

The authors assessed the relation between cigarette smoking and nonspecific inflammatory bowel disease in a case-control study of 124 cases of ulcerative colitis, 109 cases of Crohn's disease, and 250 age- and sex-matched control subjects in hospital for acute nongastric or intestinal conditions unrelated to smoking. For ulcerative colitis, the risk for current smoking compared with never smoking was 0.5, with a 95% confidence interval (Cl) of 0.3–1.0. They observed decreasing risk with increasing number of cigarettes smoked. The risk for ex smokers, however, was greater than that for never smokers (relative risk = 2.7; 95% Cl = 1.5–4.9). The elevated risk of ulcerative colitis in ex-smokers in the presence of an overall lack of association with ever-smoking may plausibly be attributed to either 1) brief Induction time of a protective effect of smoking on ulcerative colitis or 2) selective cessation of smoking due perhaps to very early symptoms of the disease. if time at first onset of bowel symptoms, Instead of clinical diagnosis, is considered as the index date, the negative association between ulcerative colitis and current smoking would have weakened In men and disappeared in the overall series. There was clear evidence of a positive association between cigarette smoking and Crohn's disease (relative risk for ever smokers vs. never smokers = 4.0; 95% CI = 2.2–7.3). The risk estimates increased with the number of cigarettes smoked per day and duration of habit The association between current smoking and Crohn's disease was even stronger when age at first onset of bowel symptoms was considered as the index date, but the risk for ex-smokers fell below unity.

colitis ulcerative; Crohn's disease; smoking


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