April 16, 2001 -- Having Crohn's disease reminds 20-year-old Matt Green of the sci-fi flick Alien -- specifically the scenes where the alien bursts out of a character's stomach.
"Except that the alien never emerges. It just keeps pushing and pushing against the stomach," says Green, a computer science major and webmaster of the Teens With Crohn's Disease web site. "It's like a stomach flu that never goes away."
The pain of Crohn's disease can occur randomly or be triggered by eating the wrong food or by stress, explains Green. For many people with the disease, medications and diet can relieve most of this irritating abdominal pain. But smokers with Crohn's disease may have yet another option for pain relief -- kicking the habit.
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According to a report in the April issue of Gastroenterology, quitting seems to snuff out the painful flare-ups of this inflammatory bowel disease, a disease that is not only associated with pain, but also with diarrhea, abdominal cramps, fever, fatigue, and rectal bleeding.
"This is the first study to demonstrate that modifying smoking behavior in Crohn's disease patients can actually improve the long-term course and reduce the number of flare-ups when patients stop smoking," Stephen B. Hanauer, MD, tells WebMD after reviewing the study.
In general, smokers with Crohn's disease have more severe disease. Smokers are less likely than nonsmokers to get better with medications, and more likely to get worse after surgery to remove the involved section of intestine, says Hanauer, professor of medicine and pharmacology and director of the section of gastrointestinal disorders and nutrition at the University of Chicago Hospital.
In this study -- by Jacques Cosnes, MD, and colleagues from Rothschild Hospital in Paris, -- almost 500 smokers with Crohn's disease were counseled to stop smoking. To help them quit, the smokers took part in a program that provided them with weekly doctor visits, nicotine patches, and antidepressant drugs.
Overall, 12% of the patients quit smoking for more than one year.
About two years after the program was completed, the researchers re-evaluated the patients, both the quitters and continued smokers. They found that those who had quit smoking for more than a year had 65% fewer pain flare-ups than continued smokers.
In fact, when the researchers compared the group of quitters to a group of Crohn's patients who had never smoked in the first place, they found the groups had a similar number of disease flare-ups.
"The study was very well done," says Warwick Selby, MD, a gastroenterologist at the Royal Prince Alfred Hospital in Sydney, Australia, who commented on the study for WebMD. "The one disappointing finding was that only 12% of patients stopped smoking, despite every effort being made."
"This study reinforces the need to try to have people with Crohn's stop smoking," says Selby. "It clearly demonstrates that cessation of smoking plays at least as important a role in the treatment of Crohn's disease as do the various medications that are used."