Introduction: Tobacco smoke is an established risk factor of Crohn's disease (CD) postoperative recurrence; however, the effect of e-cigarettes and heat-not-burn tobacco (HNBT) remains unknown. We aimed to evaluate the impact of e-cigarettes and HNBT on postoperative recurrence in patients with CD. Methods: We retrospectively included consecutive patients with CD who underwent ileocolic resection and endoscopic evaluation within 1 year across 9 centers in Italy, Spain, and France. Based on smoking habits between surgery and endoscopy, patients were categorized as nonsmokers, cigarette smokers, HNBT users, or e-cigarette users. Those using multiple products were excluded. The primary outcome was endoscopic recurrence (Rutgeerts score ≥2) 1 year after surgery. Secondary analyses included modified Rutgeerts score (≥i2b), mean Rutgeerts score, transmural disease activity, fecal calprotectin, time from diagnosis to surgery, and uni- and multivariable regression analysis. Results: Nine hundred thirty-seven patients were included, of which 691 (74%) were nonsmokers, 176 (19%) conventional cigarette smokers, 37 (4%) HNBT users, and 33 (4%) e-cigarette users. Recurrence rates were significantly higher in all smoking groups compared with nonsmokers (69.4%, 63.9%, and 60.6% for traditional cigarette, HNBT, and e-cigarette users, respectively, vs 40.8% for non-smokers; all P < 0.05). The association was also observed in patients receiving pharmacological prophylaxis, using the modified Rutgeerts score cutoff of i2b, mean Rutgeerts score, and fecal calprotectin levels. In multivariable regression analysis, HNBT use remained significantly associated with recurrence (odds ratio [OR] 2.76), whereas the association for e-cigarette missed statistical significance (OR 2.02, P = 0.067). Discussion: HNBT, and possibly e-cigarettes, are associated with increased endoscopic recurrence of CD compared with nonsmoking.
The Impact of E-Cigarettes and Heat-Not-Burn Tobacco on Postoperative Recurrence of Crohn's Disease: A Multicenter International Study / Parigi, T.L., Nardone, O.M., Lisa, M., Massimino, L., Gabbiadini, R., Innocenti, T., Bertani, L., Del Gaudio, A., Florez, P., Bertin, L., Barberio, B., Hupé, M., Lopetuso, L., Allocca, M., D'Amico, F., Furfaro, F., Zilli, A., Fiorino, G., Ungaro, F., Castiglione, F., et al.. - In: THE AMERICAN JOURNAL OF GASTROENTEROLOGY. - ISSN 0002-9270. - ELETTRONICO. - (2025), pp. 0-0. [10.14309/ajg.0000000000003810]
The Impact of E-Cigarettes and Heat-Not-Burn Tobacco on Postoperative Recurrence of Crohn's Disease: A Multicenter International Study
Innocenti, Tommaso;Dragoni, Gabriele;
2025
Abstract
Introduction: Tobacco smoke is an established risk factor of Crohn's disease (CD) postoperative recurrence; however, the effect of e-cigarettes and heat-not-burn tobacco (HNBT) remains unknown. We aimed to evaluate the impact of e-cigarettes and HNBT on postoperative recurrence in patients with CD. Methods: We retrospectively included consecutive patients with CD who underwent ileocolic resection and endoscopic evaluation within 1 year across 9 centers in Italy, Spain, and France. Based on smoking habits between surgery and endoscopy, patients were categorized as nonsmokers, cigarette smokers, HNBT users, or e-cigarette users. Those using multiple products were excluded. The primary outcome was endoscopic recurrence (Rutgeerts score ≥2) 1 year after surgery. Secondary analyses included modified Rutgeerts score (≥i2b), mean Rutgeerts score, transmural disease activity, fecal calprotectin, time from diagnosis to surgery, and uni- and multivariable regression analysis. Results: Nine hundred thirty-seven patients were included, of which 691 (74%) were nonsmokers, 176 (19%) conventional cigarette smokers, 37 (4%) HNBT users, and 33 (4%) e-cigarette users. Recurrence rates were significantly higher in all smoking groups compared with nonsmokers (69.4%, 63.9%, and 60.6% for traditional cigarette, HNBT, and e-cigarette users, respectively, vs 40.8% for non-smokers; all P < 0.05). The association was also observed in patients receiving pharmacological prophylaxis, using the modified Rutgeerts score cutoff of i2b, mean Rutgeerts score, and fecal calprotectin levels. In multivariable regression analysis, HNBT use remained significantly associated with recurrence (odds ratio [OR] 2.76), whereas the association for e-cigarette missed statistical significance (OR 2.02, P = 0.067). Discussion: HNBT, and possibly e-cigarettes, are associated with increased endoscopic recurrence of CD compared with nonsmoking.
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