Cigarette smoking is a risk factor for the induction and severity of the course of Crohn’s disease (CD). Hospital admission may be required for treatment of the disease but is generally not available solely for smoking cessation. Outpatient group therapy is readily available, however long-term quit rates are limited. Residential treatment for smoking cessation may offer a more intense contact between patient and therapist, and may result in higher abstinence rates in a sensitive group of patients. The objective of this pilot study is to evaluate the feasibility of implementing a residential program with hospital admission, exclusively for smoking cessation for patients suffering from CD.

Twelve eligible smokers suffering from CD were recruited for a 9-day inpatient smoking cessation treatment. Treatment consisted of single and group behavioral therapy together with supportive measures such as exercise therapy, relaxation techniques or nutritional counselling. Nicotine replacement therapy or prescription medication was offered according to the Fagerström test for nicotine dependence (FTND) score and treatment guidelines. Quit rates were assessed by CO-testing during hospital treatment and by follow-up calls 6 months after discharge.

All recruited participants arrived on time for treatment and collectively stopped smoking on the 2nd day after admission. All participants completed the therapy process without relapse and left the hospital smoke-free (100% quit rate on discharge, CO monitored). Self-reported abstinence rates after 6 months were 72.7% for continuous abstinence and 81.8% for 7-day point prevalence abstinence.

Residential treatment exclusively for smoking cessation is feasible and efficient and may be a valuable treatment option for patients suffering from CD.

Smoking has detrimental effects on Crohn’s disease (CD) activity while data on ulcerative colitis (UC) are conflicting. Little is known about the use and impact of alternative smoking products in inflammatory bowel diseases (IBD).

To understand the patients’ perceptions of the impact of smoking on their IBD and to assess differences between CD and UC patients.

The questionnaire was developed by Philip Morris Products SA in cooperation with European Federation of Crohn's and Ulcerative Colitis Associations. The final survey questionnaire consisted of 41 questions divided in 8 categories: (1) Subject screener; (2) Smoking history; (3) Background information; (4) IBD disease background; (5) Current disease status; (6) Current therapeutics and medications; and (7) Current nicotine/cigarettes use and awareness of the impacts of smoking on IBD. The questionnaire was submitted online from 4^th November 2019 to 11th March 2020 through the European Federation of Crohn's and Ulcerative Colitis Associations website to IBD patients who were current smokers or had a history of smoking.

In total 1050 IBD patients speaking nine languages participated to the survey. Among them, 807 (76.9%) patients declared to have ever smoked or consumed an alternative smoking product, with a higher proportion of current cigarette smokers among CD patients (CD: 63.1% vs UC: 54.1%, P = 0.012). About two-thirds of the participants declared to have ever stopped cigarette smoking and restarted (67.0%), with a significantly higher proportion among UC patients compared to CD patients (73.1% vs 62.0%, P = 0.001). We also found significant differences between CD and UC patients in the awareness of the health consequences of smoking in their disease and in the perceived impact of smoking on disease activity, for both cigarettes and alternative smoking products.

This survey found significant differences between CD and UC patients in both awareness and perception of the impact of smoking on their disease. Further efforts should be done to encourage smoking cessation for all IBD patients, including UC patients.

• Inflammatory bowel disease
• Ulcerative colitis
• Crohn's disease
• Cigarettes
• Alternative smoking products
• Tobacco
• Nicotine
• Marijuana

• Colitis, Ulcerative/diagnosis
• Colitis, Ulcerative/epidemiology
• Colitis, Ulcerative/therapy
• Crohn Disease/diagnosis
• Crohn Disease/epidemiology
• Humans
• Inflammatory Bowel Diseases
• Risk Factors
• Smoking/adverse effects
• Surveys and Questionnaires

Cigarette smoking is the most important risk factor for Crohn’s disease (CD). The effectiveness of smoking cessation programs (SCPs) in patients with CD is still poorly understood.

This was a retrospective, observational, single-centre, cohort study of 136 active smokers with mean age 55 years (SD=11), 58% males, including 27 (19.8%) patients with CD who entered the multidisciplinary SCP of the Luigi Sacco University Hospital of Milan from January 2017 through January 2019. A pulmonologist was responsible for the clinical and pharmacological management, while a psychiatrist and a psychologist conducted the counselling and assessed the motivation to quit, anxiety and depression using the Brief Psychiatric Rating Scale (BPRS) and the nicotine dependence with the Fagerström test. Patients were defined as quitters after 12 months.

Demographic and clinical characteristics, and Fagerström score, did not differ in patients with and without CD. At baseline, patients with CD had a higher BPRS (median: 27, IQR: 22–32; vs 25 and 22–28.5; p=0.03), and a lower motivation to quit score (median: 10, IQR: 9–13; vs 14 and 12–15; p<0.001). After 12 months, the quitting rate of smokers with CD was significantly lower (14.8% vs 36.7%; p<0.022) and the chance of quitting was negatively associated with the baseline BPRS (r=-0.256; p<0.003). Varenicline and nicotine replacement therapy tended to be less effective in patients with CD.

The lower efficacy of SCPs in patients with CD might be secondary to a higher prevalence of anxiety and depression. Psychological issue recognition and support should be enhanced to increase SCP effectiveness in CD.

• Crohn’s disease
• anxiety
• depression
• nicotine
• smoking cessation

• Biomedical Research
• Crohn Disease/complications
• Humans
• Smoking/adverse effects
• Smoking Cessation

• Crohn's disease
• inflammatory bowel disease
• ulcerative colitis

• Adult
• Crohn Disease/etiology
• Directive Counseling
• Female
• Follow-Up Studies
• Humans
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Patient Acceptance of Health Care/statistics & numerical data
• Patient Education as Topic
• Physician-Patient Relations
• Prospective Studies
• Smoking/adverse effects
• Smoking/therapy
• Smoking Cessation/methods
• Smoking Cessation/statistics & numerical data
• Treatment Outcome

• Complications
• Crohn’s disease
• Recurrence
• Smoking cessation
• Therapy
• Tobacco

• Crohn Disease/diagnosis
• Crohn Disease/etiology
• Crohn Disease/prevention & control
• Crohn Disease/therapy
• Humans
• Prognosis
• Recurrence
• Remission Induction
• Smoking/adverse effects
• Smoking Cessation

• Humans
• Inflammatory Bowel Diseases/epidemiology
• Inflammatory Bowel Diseases/etiology
• Odds Ratio
• Prevalence
• Risk Factors
• Smoking/adverse effects
• Smoking/epidemiology
• United States/epidemiology

• Colitis, Ulcerative/epidemiology
• Colitis, Ulcerative/etiology
• Colitis, Ulcerative/physiopathology
• Crohn Disease/epidemiology
• Crohn Disease/etiology
• Crohn Disease/physiopathology
• Humans
• Nicotine
• Smoking/adverse effects

• Colitis, Ulcerative/etiology
• Colitis, Ulcerative/physiopathology
• Colitis, Ulcerative/therapy
• Crohn Disease/etiology
• Crohn Disease/physiopathology
• Crohn Disease/therapy
• Humans
• Smoking/adverse effects
• Smoking Cessation