Smoking and disease recurrence after operation for Crohn's disease

Background: There is increasing speculation about the role of smoking in the pathogenesis of inflammatory bowel diseases. The purpose of this study is to review the impact of smoking on disease recurrence after operation for Crohn's disease. Methods: A Medline-based literature review (1966-1999) was carried out; ten studies examined the relationship between smoking and disease recurrence after operation. Results: Approximately half of the patients were smokers at the time of operation. In most studies smoking significantly increased the risk of postoperative disease recurrence. Smokers had an approximately twofold increased risk of recurrence compared with non-smokers and the effect of smoking was dose dependent. The increased risk of recurrence among smokers was more prominent in women than in men, and a longer duration of smoking increased the risk of recurrence. Ex-smokers had a similar recurrence rate to non-smokers and giving up smoking soon after operation was associated with a lower probability of recurrence. Conclusion: Smoking significantly increases the risk of recurrence of disease after operation for Crohn's disease, especially in women and heavy smokers. Encouraging patients to stop smoking is an important part of the management of Crohn's disease.