Cigarette Smoking, Inflammatory Bowel Disease & Irritable Bowel Syndrome

Despite many attempts by the tobacco industry to refute the detrimental health effects of cigarette smoking, it is now unequivocally known by both the medical fraternity and smokers alike that cigarette smoking is harmful. Every now and then snippets of information about the supposed beneficial or at least protective effect of cigarette smoking makes its rounds in the news. This is often misunderstood by smokers to mean that cigarette smoking may be helpful in some regard and encourages the habit. Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are two bowel conditions where this misconception arises.

IBD and Cigarette Smoking

Inflammatory bowel disease (IBD) is a chronic condition characterized by varying degrees of inflammation of the bowels. The two main types are Crohn’s disease and ulcerative colitis. Crohn’s disease may arise in any part of the gut but is usually isolated to the terminal part of the small intestine (ileum) and colon, where ulcerative colitis only arises in the colon and/or rectum. Both conditions are believed to be due to a defective immune response that is genetically acquired. Diarrhea, with/without blood and mucus, abdominal pain and weight loss are some of the features seen in IBD.

Cigarette smoking appears to have an effect on both conditions. Crohn’s disease is more likey to be caused and exacerbated by cigarette smoking. On the other hand, ulcerative colitis is less likely to occur in smokers and therefore higher rates are seen among non-smokers and those who have previously smoked. This, however, is not a justification to begin smoking for ulcerative colitis sufferers. Various studies and clinical observations have found that cigarette smoking reduces the effectiveness of treatment and complicates the management.

IBS and Cigarette Smoking

Irritable bowel syndrome (IBS) is a functional disorder of the bowels which appears to be due to a dysfunction in the gastrointestinal motility. As a functional disorder, there is no evident abnormalities in the bowel anatomy, pathological changes or clearly understood mechanism contributing to this condition. Some patients have diarrhea-predominant IBS while others have constipation-predominant IBS. Although the exact cause of IBS is not known, certain stimuli serves as triggers particularly in acute flareups.

Cigarette smoking is one of these known triggers, particularly in diarrhea-predominant IBS. Smokers are more likely to have diarrhea or at least more frequent bowel movements which is often uncontrollable. Smoking cessation on the other hand appears to improve the overall presentation of the condition. On the other hand, patients with constipation-predominant IBS sometimes report and improvement in bowel regularity with cigarette smoking. However, this is often short-lived and it is possible, although not conclusively verifiable, that cigarette smoking will exacerbate constipation-predominant IBS in the long run.

Nicotine, IBD and IBS

The use of nicotine patches in certain bowel conditions like IBD and IBS should not be a justification to continue smoking. Nicotine may aid with bowel motility but if used, it has to be administered in control doses via other routes like patches. Cigarettes do not only deliver nicotine to the system, but scores of noxious chemicals many of which are carcinogenic (cancer-causing chemicals). In conditions like IBD where there is an increased risk of colorectal cancer, cigarette smoking only serves to increase the risk of developing cancer due to the constant exposure to carcinogens.

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