Smoking is Associated With Extra-intestinal Manifestations in Inflammatory Bowel Disease

M. Severs, S. J. H. van Erp, M.E. van der Valk, M. J. Mangen, H. H. Fidder, M.M. van der Have, A. van Bodegraven, D. J. de Jong, C. Janneke van der Woude, Marielle J. L. Romberg-Camps, C.H.M. Clemens, J. M. Jansen, P.C. van de Meeberg, N. Mahmmod, C. Y. Ponsioen, C. Bolwerk, J. R. Vermeijden, M. J. Pierik, Peter D. Siersema, M. LeendersA. E. van der Meulen Jong, G. Dijkstra, B. Oldenburg*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


BACKGROUND AND AIMS: Smoking affects the course of disease both in patients with ulcerative colitis (UC) and Crohn's disease (CD). We aimed to study the association between smoking and extra-intestinal manifestations (EIMs) in Inflammatory Bowel Disease (IBD). METHODS: We cross-sectionally explored the association between smoking and EIMs in IBD in three cohort studies: 1. the COIN-cohort, designed to estimate healthcare expenditures in IBD, 2. the Groningen-cohort, focused on cigarette smoke exposure and disease behaviour in IBD and 3. the JOINT-cohort, evaluating joint and back manifestations in IBD. RESULTS: In the COIN-, Groningen-, and JOINT-cohort, 3,030, 797 and 225 patients were enrolled of whom 16%, 24% and 23.5% were current smokers, respectively. Chronic skin disorders and joint manifestations were more prevalent in smoking IBD patients than in non-smokers (COIN-cohort: 39.1% vs. 29.8%, p <0.01; Groningen-cohort: 41.7% vs. 30.0%, p <0.01), in both CD and UC. In the JOINT-cohort, smoking was more prevalent in IBD patients with joint manifestations than in those without (30.3% vs. 13.0%, p <0.01). EIMs appeared to be more prevalent in high than in low-exposure smokers (56.0% vs. 37.1%, p = 0.10). After smoking cessation, the prevalence of EIMs in IBD patients rapidly decreased towards levels of never smokers (lag time COIN-cohort: 1-2 years, Groningen-cohort: within one year). CONCLUSIONS: There is a robust dose-dependent association between active smoking and EIMs in both CD and UC patients. Smoking cessation was found to result in a rapid reduction of EIM prevalence to levels encountered in never smokers.
Original languageEnglish
Pages (from-to)455-461
Number of pages7
JournalJournal of Crohn's & Colitis
Issue number4
Publication statusPublished - Apr 2016


  • Inflammatory bowel disease
  • extra-intestinal manifestations
  • smoking

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