Skip to main content
NCBI home page
Gut logoLink to Gut
. 1996 Mar;38(3):362–364. doi: 10.1136/gut.38.3.362

Smoking may prevent pouchitis in patients with restorative proctocolectomy for ulcerative colitis.

M N Merrett 1, N Mortensen 1, M Kettlewell 1, D O Jewell 1
PMCID: PMC1383063  PMID: 8675087

Abstract

Epidemiological studies have shown an increased risk of ulcerative colitis (UC) in non-smokers and particularly recent ex-smokers. Patients with UC have an increased risk of pouchitis following ileal pouch-anal anastomosis, which may be a manifestation of the original disease susceptibility. The aim of this study was to test the hypothesis that smoking habit may influence the incidence of pouchitis. All patients with a functioning pouch > or = 12 months at one centre were assessed. Patients were excluded if (a) the original indication was not UC (n = 5), (b) the excised pouch showed histology diagnostic of Crohn's disease (n = 2), and (c) data were inadequate (n = 4). Smoking data were collected by questionnaire, or direct interview, or both. Ex-smokers were those who had stopped smoking < 7 years before colectomy. Non-smokers included ex-smokers who had stopped > 7 years before colectomy. Pouchitis was defined as an increase in stool frequency > 8/day with acute inflammation on biopsy specimen histology. Each presentation requiring treatment was regarded as an episode. For comparison smoking habit was assessed with regard to three other adverse outcomes - haemorrhage, sepsis, and pouch excision. Of 72 non-smokers (mean follow up 3.5 years) 18 had 46 episodes of pouchitis. Of 12 ex-smokers (mean follow up 3.3 years) four patients have had 14 episodes of pouchitis. Only one smoker from 17 has had a single episode of pouchitis. This shows that smokers have significantly less episodes of pouchitis compared with non-smokers (p = 0.0005) and ex-smokers (p = 0.05). There was no association of smoking habit with other adverse outcomes.

Full text

PDF
362

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bhapkar V. P. On the analysis of contingency tables with a quantitative response. Biometrics. 1968 Jun;24(2):329–338. [PubMed] [Google Scholar]
  2. Cope G. F., Heatley R. V., Kelleher J. K. Smoking and colonic mucus in ulcerative colitis. Br Med J (Clin Res Ed) 1986 Aug 23;293(6545):481–481. doi: 10.1136/bmj.293.6545.481. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Dozois R. R., Goldberg S. M., Rothenberger D. A., Utsunomiya J., Nicholls R. J., Cohen Z., Hultén L. A., Moskowitz R. L., Williams N. S. Restorative proctocolectomy with ileal reservoir. Int J Colorectal Dis. 1986 Jan;1(1):2–19. doi: 10.1007/BF01648830. [DOI] [PubMed] [Google Scholar]
  4. Galandiuk S., Scott N. A., Dozois R. R., Kelly K. A., Ilstrup D. M., Beart R. W., Jr, Wolff B. G., Pemberton J. H., Nivatvongs S., Devine R. M. Ileal pouch-anal anastomosis. Reoperation for pouch-related complications. Ann Surg. 1990 Oct;212(4):446–454. doi: 10.1097/00000658-199010000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Harries A. D., Baird A., Rhodes J. Non-smoking: a feature of ulcerative colitis. Br Med J (Clin Res Ed) 1982 Mar 6;284(6317):706–706. doi: 10.1136/bmj.284.6317.706. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Holt P. G. Immune and inflammatory function in cigarette smokers. Thorax. 1987 Apr;42(4):241–249. doi: 10.1136/thx.42.4.241. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Jick H., Walker A. M. Cigarette smoking and ulcerative colitis. N Engl J Med. 1983 Feb 3;308(5):261–263. doi: 10.1056/NEJM198302033080507. [DOI] [PubMed] [Google Scholar]
  8. Knobler H., Ligumsky M., Okon E., Ayalon A., Nesher R., Rachmilewitz D. Pouch ileitis--recurrence of the inflammatory bowel disease in the ileal reservoir. Am J Gastroenterol. 1986 Mar;81(3):199–201. [PubMed] [Google Scholar]
  9. Köhler L. W., Pemberton J. H., Zinsmeister A. R., Kelly K. A. Quality of life after proctocolectomy. A comparison of Brooke ileostomy, Kock pouch, and ileal pouch-anal anastomosis. Gastroenterology. 1991 Sep;101(3):679–684. [PubMed] [Google Scholar]
  10. Levin K. E., Pemberton J. H., Phillips S. F., Zinsmeister A. R., Pezim M. E. Role of oxygen free radicals in the etiology of pouchitis. Dis Colon Rectum. 1992 May;35(5):452–456. doi: 10.1007/BF02049401. [DOI] [PubMed] [Google Scholar]
  11. Lindberg E., Tysk C., Andersson K., Järnerot G. Smoking and inflammatory bowel disease. A case control study. Gut. 1988 Mar;29(3):352–357. doi: 10.1136/gut.29.3.352. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Luukkonen P., Valtonen V., Sivonen A., Sipponen P., Järvinen H. Fecal bacteriology and reservoir ileitis in patients operated on for ulcerative colitis. Dis Colon Rectum. 1988 Nov;31(11):864–867. doi: 10.1007/BF02554850. [DOI] [PubMed] [Google Scholar]
  13. Luukkonen P., Valtonen V., Sivonen A., Sipponen P., Järvinen H. Fecal bacteriology and reservoir ileitis in patients operated on for ulcerative colitis. Dis Colon Rectum. 1988 Nov;31(11):864–867. doi: 10.1007/BF02554850. [DOI] [PubMed] [Google Scholar]
  14. Madden M. V., Farthing M. J., Nicholls R. J. Inflammation in ileal reservoirs: 'pouchitis'. Gut. 1990 Mar;31(3):247–249. doi: 10.1136/gut.31.3.247. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Mortensen N. Progress with the pouch--restorative proctocolectomy for ulcerative colitis. Gut. 1988 May;29(5):561–565. doi: 10.1136/gut.29.5.561. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Moskowitz R. L., Shepherd N. A., Nicholls R. J. An assessment of inflammation in the reservoir after restorative proctocolectomy with ileoanal ileal reservoir. Int J Colorectal Dis. 1986 Jul;1(3):167–174. doi: 10.1007/BF01648445. [DOI] [PubMed] [Google Scholar]
  17. Motley R. J., Rhodes J., Ford G. A., Wilkinson S. P., Chesner I. M., Asquith P., Hellier M. D., Mayberry J. F. Time relationships between cessation of smoking and onset of ulcerative colitis. Digestion. 1987;37(2):125–127. doi: 10.1159/000199478. [DOI] [PubMed] [Google Scholar]
  18. Motley R. J., Rhodes J., Kay S., Morris T. J. Late presentation of ulcerative colitis in ex-smokers. Int J Colorectal Dis. 1988 Aug;3(3):171–175. doi: 10.1007/BF01648362. [DOI] [PubMed] [Google Scholar]
  19. Nasmyth D. G., Godwin P. G., Dixon M. F., Williams N. S., Johnston D. Ileal ecology after pouch-anal anastomosis or ileostomy. A study of mucosal morphology, fecal bacteriology, fecal volatile fatty acids, and their interrelationship. Gastroenterology. 1989 Mar;96(3):817–824. [PubMed] [Google Scholar]
  20. O'Connell P. R., Rankin D. R., Weiland L. H., Kelly K. A. Enteric bacteriology, absorption, morphology and emptying after ileal pouch-anal anastomosis. Br J Surg. 1986 Nov;73(11):909–914. doi: 10.1002/bjs.1800731121. [DOI] [PubMed] [Google Scholar]
  21. Osborne M. J., Stansby G. P. Cigarette smoking and its relationship to inflammatory bowel disease: a review. J R Soc Med. 1992 Apr;85(4):214–216. doi: 10.1177/014107689208500412. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Pemberton J. H., Kelly K. A., Beart R. W., Jr, Dozois R. R., Wolff B. G., Ilstrup D. M. Ileal pouch-anal anastomosis for chronic ulcerative colitis. Long-term results. Ann Surg. 1987 Oct;206(4):504–513. doi: 10.1097/00000658-198710000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Pena J. P., Gemlo B. T., Rothenberger D. A. Ileal pouch-anal anastomosis: state of the art. Baillieres Clin Gastroenterol. 1992 Mar;6(1):113–128. doi: 10.1016/0950-3528(92)90022-7. [DOI] [PubMed] [Google Scholar]
  25. Persson P. G., Ahlbom A., Hellers G. Inflammatory bowel disease and tobacco smoke--a case-control study. Gut. 1990 Dec;31(12):1377–1381. doi: 10.1136/gut.31.12.1377. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Phillips R. K. Pelvic pouches. Br J Surg. 1991 Sep;78(9):1025–1026. doi: 10.1002/bjs.1800780902. [DOI] [PubMed] [Google Scholar]
  27. Prytz H., Benoni C., Tagesson C. Does smoking tighten the gut? Scand J Gastroenterol. 1989 Nov;24(9):1084–1088. doi: 10.3109/00365528909089259. [DOI] [PubMed] [Google Scholar]
  28. Rasp F. L., Clawson C. C., Hoidal J. R., Repine J. E. Reversible impairment of the adherence of alveolar macrophages from cigarette smokers. Am Rev Respir Dis. 1978 Dec;118(6):979–986. doi: 10.1164/arrd.1978.118.6.979. [DOI] [PubMed] [Google Scholar]
  29. Rauh S. M., Schoetz D. J., Jr, Roberts P. L., Murray J. J., Coller J. A., Veidenheimer M. C. Pouchitis--is it a wastebasket diagnosis? Dis Colon Rectum. 1991 Aug;34(8):685–689. doi: 10.1007/BF02050351. [DOI] [PubMed] [Google Scholar]
  30. Somerville K. W., Logan R. F., Edmond M., Langman M. J. Smoking and Crohn's disease. Br Med J (Clin Res Ed) 1984 Oct 13;289(6450):954–956. doi: 10.1136/bmj.289.6450.954. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Srivastava E. D., Barton J. R., O'Mahony S., Phillips D. I., Williams G. T., Matthews N., Ferguson A., Rhodes J. Smoking, humoral immunity, and ulcerative colitis. Gut. 1991 Sep;32(9):1016–1019. doi: 10.1136/gut.32.9.1016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Tobin M. V., Logan R. F., Langman M. J., McConnell R. B., Gilmore I. T. Cigarette smoking and inflammatory bowel disease. Gastroenterology. 1987 Aug;93(2):316–321. doi: 10.1016/0016-5085(87)91021-3. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES