Pattern of Electronic Cigarette Use and Its Impact on Patients With Inflammatory Bowel Disease
AIBD 2023
Background:
The relationship between cigarette use and inflammatory bowel disease (IBD) activity has been well documented in the literature. Electronic cigarettes (e-cigarettes) are relatively new to the market, and their effects on IBD activity have not yet been characterized well. We aimed determine the pattern of e-cigarette use among IBD patients and evaluate the impact of e-cigarette use on several disease-related outcomes.
Methods:
Adult patients with Crohn’s disease (CD), Ulcerative Colitis (UC), or Indeterminate Colitis (IBD-U) attending IBD clinics at the University of Rochester were invited to complete a brief questionnaire about their use of e-cigarettes and other tobacco products. Following this, we performed chart reviews to determine their disease-related outcomes including changes in medications, steroid use, IBD-related ED visits, and IBD-related hospitalizations – all within 1 year of their entry into the study – and ever having had an IBD-related surgery.
Results:
A total of 203 patients were included in our study, of whom 174 (85.7%) were never e-cigarette users, and 29 (14.3%) were current or former e-cigarette users. Compared to never users, patients who had ever used e-cigarettes were younger (median age of 31 vs. 52 years, p < 0.001) and more likely to be current or former smokers (69% vs. 33%, p < 0.001). The two groups were comparable regarding other demographic and disease-related characteristics including gender, race, disease type, disease severity and therapies. Regarding e-cigarette use behavior, most of the patients started using e-cigarettes before the age of 30 (18/29, 62%). Majority of the patients used e-cigarettes multiple times per day (16/29, 55.2%), with 27.6% using within 5-10 minutes after waking up. One of the most common reasons for using e-cigarettes was to attempt to quit smoking (13/29, 44.8%), so unsurprisingly, most patients used only nicotine e-liquid (22/29, 75.8%). A minority of our patients used cannabis e-liquid (N = 3, 10.3%) or both nicotine and cannabis (N = 3, 10.3%). All the patients who used cannabis e-liquid chose a variety that contained THC. In univariate and multivariate analyses adjusting for age, gender, cigarette smoking status, disease type, disease severity (complicated phenotypes), and level of medical therapy, e-cigarette use had no significant impact on any of the five disease outcomes of interest. Percent of patients with changes in medication was 27.6% among never e-cigarette users and 27.6% among ever users (p-value > 0.99). Other outcomes were also similar between the two groups [steroid use 20.1% vs. 27.6%, IBD-related ED visits 5.7% vs. 6.9%, IBD-related ED visits hospitalization 6.9% vs. 13.8% and ever having had an IBD-related surgery 29.9% vs. 24.1%, respectively, in never users and ever users; all p > 0.05.
Conclusions:
In this single-center IBD population, e-cigarette use was common (14.3%), especially in younger patients who were current or former smokers. Nonetheless, e-cigarette use had no significant impact on disease-related outcomes including changes in medications, steroid use, ED visits, and hospitalizations – all within 1 year of their entry into the study – and ever having had an IBD-related surgery. Larger population-based studies are needed to verify these findings.
