TITLE

Cigarette Smoking and Appendectomy are Risk Factors for Extraintestinal Manifestations in Ulcerative Colitis

AUTHOR(S)
Manguso, F.; Sanges, M.; Staiano, T.; Gargiulo, S.; Nastro, P.; Gargano, D.; Somma, P.; Mansueto, G.; Peluso, R.; Scarpa, R.; D'Armiento, F. P.; Astarita, C.; Ayala, F.; Renda, A.; Mazzacca, G.; D'Arienzo, A.
PUB. DATE
February 2004
SOURCE
American Journal of Gastroenterology;Feb2004, Vol. 99 Issue 2, p327
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
OBJECTIVE: Two common factors, cigarette smoking and appendectomy, have been found to play a role in ulcerative colitis (UC). Data on their role in the development of extraintestinal manifestations (EIM) are scarce.METHODS: The relationship between cigarette smoking, appendectomy, and EIM was examined in a prospective study involving 535 (M/F= 319/216) consecutive UC patients followed up for 18 yr. We considered the major EIM: seronegative spondyloarthropathy, pyoderma gangrenosum/erythema nodosum, acute anterior uveitis, and primary sclerosing cholangitis. We excluded patients with a history of EIM or those colectomized before study entry, ex-smokers, and those who started to smoke during the course of UC.RESULTS: In UC patients, seronegative spondyloarthropathy and dermatologic complications were found increased in smokers (p<0.0001;p= 0.001) or in subjects with appendectomy (p= 0.0003;p= 0.02), while acute anterior uveitis and primary sclerosing cholangitis did not differ. The Kaplan-Meier analysis showed 18-yr rates for EIM of 71% in smokers and 45% in nonsmokers (log-rank test,p= 0.0001), and of 85% in patients with appendectomy and 48% in those without (p= 0.0001). Cox proportional-hazard model showed that cigarette smoking and appendectomy are independent factors promoting EIM. In smokers with appendectomy the adjusted hazard ratio (3.197, 95% CI 1.529–6.684) was higher than in patients with appendectomy alone (2.617, 95% CI 1.542–4.442) or smoking alone (1.947, 95% CI 1.317–2.879).In UC patients, appendectomy and cigarette smoking are prognostic factors for the development of EIM. The unfavorable effect of cigarette smoking on EIM is additive to that of appendectomy.
ACCESSION #
14816746

 

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