Role of smoking in inflammatory bowel disease: implications for therapy

The relationship between smoking and inflammatory bowel disease is now firmly established but remains a source of confusion among both patients and doctors. It is negatively associated with ulcerative colitis but positively associated with Crohn's disease. In addition, it has opposite influences on the clinical course of the two conditions with benefit in ulcerative colitis but a detrimental effect in Crohn's disease. These differences have been the subject of much interest and scrutiny with the hope that they may offer some insight into the pathogenesis of the two conditions and possibly lead to alternative therapeutic options. Nicotine is probably the principal active ingredient in smoking responsible for the association; trials have shown it to be of some benefit in ulcerative colitis, but further research is required to establish its therapeutic role, and the relevant mechanisms responsible for its action. In this article, we review the role of smoking in inflammatory bowel disease and its implication for therapy.     

Chronic inflammatory bowel disease, cigarette smoking, and use of oral contraceptives: findings in a large cohort study of women of childbearing age

Since the start in 1968 of the Oxford Family Planning Association contraceptive study 31 women have developed ulcerative colitis and 18 have developed Crohn's disease, giving incidences of 0.15 and 0.09/1000 woman years respectively. The incidence of ulcerative colitis in women who were non-smokers on entry to the study was 0.17/1000 woman years and the incidence in smokers was 0.11/1000 woman years. The findings for Crohn's disease were entirely different, the corresponding incidences being 0.05 and 0.17/1000 woman years respectively. Both ulcerative colitis and Crohn's disease were more common among women currently using oral contraceptives than among those not doing so. Incidences per 1000 woman years for ulcerative colitis were 0.26 in users and 0.11 in non-users; for Crohn's disease the incidences were 0.13 and 0.07 respectively. Though the association between the use of oral contraceptives and chronic inflammatory bowel disease cannot be regarded as established, the effects of smoking have been shown consistently in many studies. This observation provides an important clue to the aetiology of chronic inflammatory bowel disease.     

张声生教授从内痈论治溃疡性结肠炎经验

张声生教授治疗溃疡性结肠炎积累了丰富的经验,认为本病与内痈发病十分相似,治疗上可汲取中医外科治痈的宝贵经验,从“内痈”入手,分期论治,宏微相参,病证结合,配合中药局部灌肠,收效颇丰,并附病案举隅。     

小剂量低分子肝素治疗活动性溃疡性结肠炎2例临床分析

溃疡性结肠炎是临床常见病,部分患者常规治疗效果欠佳,与局部黏膜毛细血管高凝状态和(或)微血栓形成有一定关系。小剂量低分子肝素因其出血发生率低,不用检测出、凝血时间,应用方便,治疗初发性或复发性活动性溃疡性结肠炎患者安全有效。     

Clinical study on 118 cases of ulcerative colitis treated by integration of traditional Chinese and Western medicine.

118 cases of ulcerative colitis were treated by integration of traditional Chinese and Western medicine. Another 86 cases of ulcerative colitis were treated by simple western drugs as controls. The therapeutic effects for both groups were observed and compared after two therapeutic courses of 40 consecutive days. As a result, 39 cases were cured, 60 cases improved and 19 cases failed, with a total effective rate of 84% in the treatment group; in the control group, 15 cases were cured, 37 cases improved and 34 cases failed, with a total effective rate of 60.5%. Statistically, the difference was very significant (P < 0.01). It can be concluded that treatment of ulcerative colitis by the integrated method is superior to that by simple western drugs.     

Effects of nicotine chewing gum on UPDRS score and P300 in early-onset parkinsonism

It has been reported that nicotine shows some beneficial effects on Parkinson's disease. The purpose of the present study is to assess the therapeutic effects of nicotine chewing gum in patients with early-onset parkinsonism (EOP). The subjects were 8 patients with early-onset parkinsonism (male/female = 4/4, mean age; 51.3 years). Four out of 8 patients had a history of smoking (smokers). To estimate the effects of nicotine gum, the scores on the Unified Parkinson's Disease Rating Scale (UPDRS) and auditory event-related potentials (ERPs) were studied before and after taking nicotine gum in the EOP patients. In smokers, UPDRS scores improved by more than 10% and the P300 latency of auditory ERPs was shortened by more than 30 msec. In contrast, nicotine had no remarkable effects on UPDRS scores or auditory ERPs in non-smokers. We suggest that nicotine chewing gum may be a possible choice for the treatment of patients with EOP, especially when they are smokers.     

Smoking and Crohn's disease

In a case-control study 82 patients with Crohn's disease and matched controls drawn from general practice lists were questioned about their smoking habits. Patients with Crohn's disease were significantly more likely to be smokers than the controls, and the association was stronger for smoking habit before the onset of the disease than for current smoking habit, the relative risks for smokers compared with non-smokers being 4.8 and 3.5 respectively. Taken in conjunction with earlier data showing an association between non-smoking and ulcerative colitis, these results suggest that smoking habit may be an important determinant of the type of inflammatory bowel disease that develops in predisposed subjects.     

中药方剂治疗溃疡性结肠炎的系统评价再评价

目的 对中药方剂治疗溃疡性结肠炎的系统评价的方法学质量和结局指标的可信度进行再评价,为临床治疗溃疡性结肠炎提供更加科学的依据。方法 在中国知网、万方数据库、维普数据库、PubMed数据库中检索有关中药方剂治疗溃疡性结肠炎的系统评价及Meta分析,检索时限均为建库至2019年2月1日。两名研究者分别独立进行文献筛选和资料提取,运用AMSTAR2量表评价纳入系统评价的方法学质量,同时采用GRADE系统对结局指标进行证据质量分级。结果 最终纳入8篇系统评价,所有系统评价均对原始研究进行了偏倚风险评估;AMSTAR2评分显示,4篇为低质量,4篇为极低质量;GRADE评级结果显示,所有结局指标中8个为高等级,11个为中等级,11个为低级,2个为极低级。结论 目前中药方剂治疗溃疡性结肠炎的系统评价的方法学质量较低,但其结局指标的可靠程度相对较高,可供指南撰写者和临床证据使用者参考。     

Salmonellosis and ulcerative colitis. A causal relationship or just a coincidence

Coincidence of salmonellosis and ulcerative colitis is a rare clinical problem. Salmonella infection was reported to complicate the ulcerative colitis, as either facilitating its occurrence or activation. In this article, we present a case with salmonellosis whose clinicopathological findings also suggested ulcerative colitis. The patient improved rapidly after taking additional mesalazine to norfloxacin treatment. We conclude that salmonella infection might have either been coincidentally present or might have triggered an early ulcerative colitis in this patient who did not have history of inflammatory bowel diseases. In case of persistent severe diarrhea despite appropriate treatment, the possibility of a coincident inflammatory bowel disease such as ulcerative colitis should always be considered, especially in endemic regions for salmonellosis.     

健脾类方剂治疗溃疡性结肠炎的临床研究进展

溃疡性结肠炎发病率日益升高,病情复杂多变,易迁延反复,甚至癌变,严重影响患者的身心健康.中医药治疗溃疡性结肠炎具有整体调节的优势,复发率低、不良反应小.众多医家"从脾论治",应用健脾类方剂治疗溃疡性结肠炎取得显著疗效.本文对近10年应用健脾类方剂如参苓白术散、理中汤、痛泻要方、四君子汤、升阳益胃汤等治疗溃疡性结肠炎的临...     

Relative incidence of Crohn's disease and ulcerative colitis in six Melbourne hospitals

Information on the relative incidence of Crohn's disease and ulcerative colitis was obtained by a prospective investigation at six Melbourne teaching hospitals. One hundred and eleven patients who presented with chronic inflammatory bowel diseases between 1980-1981 were admitted to the study. Forty (36%) patients were diagnosed as having Crohn's disease and 63 (57%) patients as having ulcerative colitis. The type of chronic inflammatory bowel disease could not be determined in eight (7%) patients. These findings suggest that the relative frequency of Crohn's disease and ulcerative colitis in Melbourne hospitals is within the range that is reported for northern Europe and the United States.     

仙方活命饮加减治疗溃疡性结肠炎（活动期）84例临床观察

目的：观察仙方活命饮加减治疗溃疡性结肠炎（活动期）临床疗效。方法：采用仙方活命饮加减口服治疗本病45例;并设对照组（关沙拉嗪肠溶片,口服）观察39例,疗程4W。结果：治疗组证候疗效有效率84．44％,对照组为71．79％（P〈0．05）;治疗组肠镜疗效有效率75．56％,与对照组相似（P〈0．05）。结论：仙方活命饮加减治疗溃疡性结肠炎（活动期）疗效明显,开拓了中医治疗该病的临床思路。     

What is the origin of ulcerative colitis? Still more questions than answers

Despite more than a century of existence as a clinical entity, the true origin of ulcerative colitis still remains elusive. Several factors probably contribute to the development of this condition. Recently discovered technologies have clarified the role of bacterial species, which may account for intestinal dysbiosis, as a factor triggering ulcerative colitis. Genetic susceptibility together with abnormal innate immunoreactivity probably comprise the essential prerequisites for the initiation and perpetuation of ulcerative colitis. Although the genetic background has been more clearly recognised in patients with Crohn's disease than in those with ulcerative colitis, some candidate loci associated with ulcerative colitis have also been intensively studied. Additionally, environmental factors may interfere with inherent predispositions to ulcerative colitis, and either suppress or reinforce them. Whatever the origin, the search for the aetiology of ulcerative colitis must have the same goal: the improvement of treatment and the quality of life in patients with ulcerative colitis.     

溃疡性结肠炎的危险因素

溃疡性结肠炎是一种慢性非特异性肠道炎症性疾病,其发病率在世界范围内有逐渐升高的趋势,其病因不明。现概括了溃疡性结肠炎发生的影响因素,其中遗传、高脂饮食、肠道细菌失调、口服避孕药、精神紧张、过敏史等是溃疡性结肠炎的危险因素;阑尾切除术可降低溃疡性结肠炎的危险性,吸烟使患溃疡性结肠炎的危险性降低。     

Does patient knowledge affect the colorectal cancer risk in ulcerative colitis?

Objectives: Formal efforts to improve patient education are associated with fewer disease complications in a number of conditions. The possible relationship between knowledge about ulcerative colitis and its cancer risk, and the development of colorectal cancer using a previously developed and validated instrument—the Crohn''s and colitis knowledge (CCKNOW) score—were investigated. Methods: The 24 item CCKNOW questionnaire was mailed to patients known to have developed colorectal cancer as a complication of ulcerative colitis (cases) and to colitics from the Leicestershire inflammatory bowel disease patient database who had not developed cancer (controls). Results: The mean (SD) CCKNOW scores for cases was 8.21 (3.02) and for controls was 8.27 (4.3). These scores did not differ significantly between cases and controls (difference 0.06, 95% confidence interval (CI) -1.7 to 1.5, p=0.9). There were four times as many members of the National Association of Crohn''s and Colitis (NACC) in the control group compared with the cancer group and patients who are members of NACC achieve statistically significantly higher scores than non-members (11.6 v 7.8, p=0.05, 95% CI -0.1 to 7.6). However, after adjusting for NACC membership, the CCKNOW score did not appear to be associated with having developed cancer (odds ratio 1.04, 95% CI 0.92 to 1.18, p=0.5). Conclusions: The CCKNOW scores were comparable in cases and controls. Thus, in a retrospective study, no evidence has been demonstrated of an association between patient knowledge and the risk of developing colorectal cancer in patients with ulcerative colitis. However, knowledge may have been increased in cases as a direct result of having had colorectal cancer as a complication of ulcerative colitis.     

Research letter: Intentions of smokers to use free nicotine replacement therapy

Public health initiatives to distribute nicotine replacement therapy free of charge as a means of promoting smoking cessation are ongoing. Are there enough smokers interested in using nicotine replacement therapy to have a substantial impact on the prevalence of smoking if this aid were distributed free to all interested smokers? We conducted a telephone survey of 825 randomly selected daily smokers aged 18 years or older who had smoked at least 10 cigarettes per day at some point in their lives. Overall, 58.9% of the respondents said they would be interested in nicotine replacement therapy if it were offered for free. Of those interested, almost all (93.8%) said that they would use the nicotine replacement therapy to help them quit for good. There were differences in the levels of interest: smokers who intended to quit were more interested in using the nicotine replacement therapy than those who planned to reduce or maintain their smoking.     

溃疡性结肠炎患者心身状态调查及应对措施

目的调查溃疡性结肠炎患者心身状态并提出应对措施。方法应用症状自评量表(SCL-90)对200例患者进行问卷调查,调查表包括躯体化症状、强迫症状、人际关系、抑郁等12个项目,将所有项目与国内常模比较。结果溃疡性结肠炎患者的各项因子得分与国内常模分数比较,差异均有统计学意义(P0.05)。结论溃疡性结肠炎患者的心理健康水平低于正常人群,在药物治疗的同时要加入心理治疗,只有使患者的身心同时进入放松状态,疾病的转归才能走向良性循环的过程。     

Smoking and ulcerative colitis

In a case-control study of smoking and ulcerative colitis patients with the disease were much less likely to smoke than community controls matched for age and sex. The difference was substantial, with an estimated relative risk of 3.8 for non-smoking on current habits, was even larger (6.2) when habits at onset of the disease were examined, and was mainly accounted for by 42 of 55 patients who had given up smoking a mean of eight years before onset. The association could not be explained by confounding by social class. These findings suggest that smoking directly or indirectly confers protection against ulcerative colitis.     

复方甘草酸苷片联合水杨酸偶氮磺胺吡啶治疗轻中度溃疡性结肠炎的临床疗效观察

目的判定复方甘草酸苷片联合水杨酸偶氮磺胺吡啶治疗轻中度溃疡性结肠炎的临床疗效。方法选择40例轻中度溃疡性结肠炎患者,随机分为两组:A组为对照组,20例,口服水杨酸偶氮磺胺吡啶;B组为实验组,20例,口服水杨酸偶氮磺胺呲啶及复方甘草酸苷片。结果实验组的总有效率高于对照组,但无明显统计学差异;联合用药组的完全缓解率高于对照组且有统计学意义。联合用药组的血清CRP水平明显降低,随访6个月后仍维持较低水平。结论在轻中度溃疡性结肠炎治疗中,复方甘草酸苷片联合水杨酸偶氮磺胺吡啶临床疗效要优于单用水杨酸偶氮磺胺吡啶,完全缓解率高,且远期疗效较好。     

吸烟者与非吸烟者对吸烟和禁烟知识态度的比较分析

在武汉市采取街道拦截法调查了１５００名市民。内容包括一般情况、吸烟情况、对吸烟和禁烟的知识、态度等。结果表明吸烟者多为中青年男性，文化程度较非吸烟者低，吸烟者对吸烟危害知识、对禁烟规定的了解及对禁烟的支持率均较非吸烟者低。ＬＯＧＩＳＴＩＣ回归分析表明，性别、文化程度、对吸烟危害的知识均能影响吸烟行为。针对影响吸烟的各因素，作者提出并探讨了若干控烟的措施及对策。