The Impact of Vaping on Crohn's Disease Endoscopic Recurrence After Resection
Conditions
Keywords
Crohn, e-cigarette, smoke, tobacco, heat-not-burn tobacco, postoperative recurrence
Brief summary
Tobacco smoke is a well-established risk factor for post-operative recurrence of Crohn's disease. Over the last few decades electronic cigarettes have gained popularity as an alternative to traditional tobacco, however, their effects on Crohn's disease are unknown. Tobacco smoke negatively impacts most outcomes of Crohn's disease including, but not limited to, response to therapy and risk of hospitalization. Smoke is particularly relevant in the post-operative setting, as it increases the chance of disease recurrence after surgical resection, and therefore prophylactic treatment with biologics is recommended in Crohn's patients who smoke. At present, there are no studies evaluating the impact of e-cigarette smoke on post-operative recurrence and therefore informing physicians on the appropriateness of prophylactic treatment in this subset of patients. This study aims to assess the impact of vaping (or smoking of electronic cigarettes) on Crohn's disease endoscopic recurrence after resection as compared to non-smoke and smoke of traditional tobacco cigarettes.
Detailed description
This is a multicenter study with the aim of evaluate the effect of e-cigarette smoke (vaping) on Crohn's disease post-operative. Secondary objectives are : * To evaluate the effect of e-cigarette smoke on Crohn's disease postoperative recurrence compared to tobacco smoke. * To determine the effect of heat-not-burn tobacco products (ie. IQOS) on Crohn's disease postoperative recurrence compared to tobacco smoke. * To determine the effect of tobacco smoke on Crohn's disease postoperative recurrence compared to nonsmokers. * To account for the confounding effect of known risk factors of post- operative recurrence: biologic treatment for postoperative prophylaxis, penetrating complications, multiple intestinal resections. The subjects considered are adult patients (≥18 years) diagnosed with CD who underwent surgical resections of a tract of intestine accessible through endoscopy.
Interventions
None listed
Sponsors
IRCCS Ospedale San Raffaele
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult (age ≥18) patients with an established diagnosis of Crohn's disease.- Patients who underwent surgical resections of a tract of intestine accessible through endoscopy. * Patients who underwent ileo-colic resections due to Crohn's disease or its complications (stricture or fistula) irrespective of the type of anastomosis (side-to-side L-L, , end-to-end T-T, end-to-side T-L, Kono S, iso or antiperistaltic) * Patients whose smoking habit (or nonsmoking habit) is clearly reported in the medical records * Data will be collected from January 2000 to August 2024.
Exclusion criteria
* Patients who underwent surgical operations different from intestinal resections (i.e. stricturoplasty raffias, dilation, bypass etc) * Patients who underwent Intestinal resections for indications other than Crohn's disease (inflammatory, stricturing or fistulizing) such as: cancer, trauma, etc * Patients who for any reason did not undergo endoscopic reassessment of the anastomosis within 12 months from surgery * Unconfirmed diagnosis of Crohn's disease * Patients whose smoking habits could not be determined * Patients with mixed smoking habits, defined as smoking at the same time tobacco cigarettes and e-cigarettes or who have changed type of smoking product (from tobacco to vaping or vice versa) after the intestinal resection and before the endoscopic reassessment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Endoscopic recurrence e-cigarettes vs no-smoke | Endoscopic recurrence will assessed within the first 12 months after an intestinal surgical resection for active or complicated Crohn's disease. | Rate of endoscopic recurrence (defined as a Rutgeerts score ≥ i2) in patients who smoke e-cigarettes in the first year after intestinal resection for active Crohn's disease compared to the endoscopic recurrence rate in patients who do not smoke. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Endoscopic recurrence e-cigarettes vs tobacco | Endoscopic recurrence assessed within the first 12 months after an intestinal surgical resection for active or complicated Crohn's disease. | The rate of endoscopic recurrence (defined as a Rutgeerts score ≥i2) in patients who smoke e-cigarettes in the first year after an intestinal resection for active Crohn's disease compared to the endoscopic recurrence rate in patients who smoke tobacco cigarettes. |
| Endoscopic recurrence tobacco vs no-smoke | Endoscopic recurrence assessed within the first 12 months after an intestinal surgical resection for active or complicated Crohn's disease. | The rate of endoscopic recurrence (defined as a Rutgeerts score ≥i2) in patients who smoke tobacco cigarettes in the first year after an intestinal resection for active Crohn's disease compared to the endoscopic recurrence rate in patients who do not smoke. |
| Endoscopic recurrence heat-not-burn tobacco vs tobacco | Endoscopic recurrence assessed within the first 12 months after an intestinal surgical resection for active or complicated Crohn's disease. | The rate of endoscopic recurrence (defined as a Rutgeerts score ≥i2) in patients who smoke heat-not-burn tobacco products in the first year after an intestinal resection for active Crohn's disease compared to the endoscopic recurrence rate in patients who smoke tobacco cigarettes. |
| Risk of recurrence | Endoscopic recurrence assessed within the first 12 months after an intestinal surgical resection for active or complicated Crohn's disease. | Odds ratio of endoscopic recurrence between e-cigarettes and non-smokers calculated with a multivariable logistic regression analysis including the following variables: biologic prophylactic treatment, intestinal resections prior to index surgery, penetrating complications |
Countries
Italy
Contacts
Primary ContactTommaso Lo Parigi, MD
Outcome results
None listed