İnflamatuar Bağırsak Hastalıklarında Sigara İçme Durumu, Karbon Monoksit Düzeyleri ile Yaşam Kalitesi ve Hastalık Özellikleri Arasındaki İlişki

Year 2023, Volume: 15 Issue: 1, 69 - 77, 15.03.2023

Yıldız Kıraç , Bektaş Yalçın , Müge Ustaoğlu

https://doi.org/10.18521/ktd.1186958

Abstract

Amaç: Bu çalışmada inflamatuar barsak hastalığı olan hastalarda sigara içme durumu ile ekshale edilen karbon monoksit (E-CO) düzeyleri, yaşam kalitesi ve hastalık özellikleri arasındaki ilişkiyi incelenmiştir.
Yöntemler: Hastanemize 01.12.2020-01.03.2021 tarihleri arasında başvuran inflamatuar bağırsak hastalığı (İBH) olan 121 hastanın demografik, hastalık özellikleri ve sigara içme durumları araştırıldı. İlk takipten sonra bu katılımcıların (E-CO) seviyeleri birbirini izleyen dört haftada bir ölçüldü. Bu E-CO okumalarının ortalaması, ana E-CO değeri olarak kabul edildi. İlk uygulamadan bir ay sonra SF-36 Yaşam Kalitesi Ölçeği uygulanarak değişkenler arasındaki ilişki araştırıldı.
Bulgular: Katılımcıların yaş ortalaması 42,06±14,9 yıl olup, %36,3'ü aktif olarak sigara içiyordu. Crohn hastalığı (CH) olan hastalar daha yüksek sigara içme oranı sergilerken, ülseratif kolitli (ÜK) sigara içenlerde anlamlı olarak daha yüksek ortalama CO ppm değerleri bulunmuştur (p<0,05). Sigara içen ÜK hastalarının genel sağlık bileşenleri içmeyenlere göre daha yüksekti (p<0,05). ÜK grubunda günlük içilen ortalama sigara sayısı, ortalama CO ppm, Fagerström Nikotin Bağımlılık Testi (FNBT), paket yılı ile SF-36'nın fiziksel ve mental bileşenleri arasında zayıf korelasyon saptandı (p<0,05). CH grubunda mental bileşenler ile ortalama E-CO arasında zayıf negatif korelasyon vardı (p=0,027). Sigara içmeyen grupta pasif içiciliğe maruz kalan katılımcılar ile böyle bir maruziyeti olmayanlar arasında fark gözlenmedi (p>0,05).
Sonuç: Sonuçlarımız, sigara içmenin ÜK tanılı hastalarda sağlık kalitesi üzerinde zayıf bir pozitif etkiye sahip olduğunu, ancak Crohn hastalarında herhangi bir etkisinin olmadığını ortaya koydu.

Keywords

Crohn hastalığı, inflamatuar barsak hastalığı, karbon monoksit, sigara, ülseratif kolit

The Relationship between Smoking Status, Carbon Monoxide Levels and Quality of Life, Disease Characteristics in Inflammatory Bowel Diseases

Abstract

Objective: The aim of the study was to analyze the relationship between smoking status and exhaled carbon monoxide (E-CO) levels, quality of life, and disease characteristics in patients with inflammatory bowel disease.
Methods: The demographic and disease characteristics and smoking status of 121 patients with inflammatory bowel disease who presented our hospital between 01.12.2020 and 01.03.2021 were investigated. After the first follow-up, the E-CO levels of these participants were measured every four consecutive weeks. The mean of these E-CO readings was accepted as the main E-CO value. After one month after their first application SF-36 Quality of Life Scale was applied. The relationship between these variables was investigated.
Results: The mean age of the participants was 42.06±14.9 years, and 36.3% were active smokers. While patients with Crohn’s disease (CD) exhibited a higher smoking rate, smokers with ulcerative colitis (UC) registered significantly higher mean CO ppm readings (p<0.05). The general health components of smoker UC patients were higher than those of non-smokers (p<0.05). A weak correlation was determined between mean number of cigarettes smoked per day, mean CO ppm, Fagerström Nicotine Dependency Test (FNDT), package year, and the physical and mental components of SF-36 in the UC group (p<0.05). There was a weak negative correlation between mental components and mean E-CO in the CD group (p=0.027). No difference was observed in the non-smoker group between participants exposed to second-hand smoke and those with no such exposure (p>0.05).
Conclusion: Our results revealed that smoking has a weak positive effect on the quality of health in patients with UC, but no effect on patients with CD.

Keywords

Carbon monoxide, Crohn, inflammatory bowel disease, SF-36, smoking, ulcerative colitis

References

• Referans 1. Xavier RJ, Podolsky DK. Unravelling the pathogenesis of inflammatory bowel disease. Nature. 2007;448(7152):427-34.
• Referans 2. Park J, Cheon JH. Incidence and Prevalence of Inflammatory Bowel Disease across Asia. Yonsei Med J. 2021;62(2):99-108.
• Referans 3. Tozun N, Atug O, Imeryuz N, Hamzaoglu HO, Tiftikci A, Parlak E, et al. Clinical characteristics of inflammatory bowel disease in Turkey: a multicenter epidemiologic survey. J Clin Gastroenterol. 2009;43(1):51-7.
• Referans 4. Ng SC, Shi HY, Hamidi N, Underwood FE, Tang W, Benchimol EI, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet. 2017;390(10114):2769-78.
• Referans 5. Allais L, Kerckhof FM, Verschuere S, Bracke KR, De Smet R, Laukens D, et al. Chronic cigarette smoke exposure induces microbial and inflammatory shifts and mucin changes in the murine gut. Environ Microbiol. 2016;18(5):1352-63.
• Referans 6. Swidsinski A, Weber J, Loening-Baucke V, Hale LP, Lochs H. Spatial organization and composition of the mucosal flora in patients with inflammatory bowel disease. J Clin Microbiol. 2005;43(7):3380-9.
• Referans 7. Vessey M, Jewell D, Smith A, Yeates D, McPherson K. Chronic inflammatory bowel disease, cigarette smoking, and use of oral contraceptives: findings in a large cohort study of women of childbearing age. Br Med J (Clin Res Ed). 1986;292(6528):1101-3.
• Referans 8. Holdstock G, Savage D, Wright R. Should patients with inflammatory bowel disease smoke? British Medical Journal (Clinical research ed). 1984;288(6420):862.
• Referans 9. Calkins BM. A meta-analysis of the role of smoking in inflammatory bowel disease. Dig Dis Sci. 1989;34(12):1841-54.
• Referans 10. Piovani D, Danese S, Peyrin-Biroulet L, Nikolopoulos GK, Lytras T, Bonovas S. Environmental Risk Factors for Inflammatory Bowel Diseases: An Umbrella Review of Meta-analyses. Gastroenterology. 2019;157(3):647-59 e4.
• Referans 11. Marinelli C, Savarino E, Inferrera M, Lorenzon G, Rigo A, Ghisa M, et al. Factors Influencing Disability and Quality of Life during Treatment: A Cross-Sectional Study on IBD Patients. Gastroenterol Res Pract. 2019;2019:5354320.
• Referans 12. Cosnes J, Beaugerie L, Carbonnel F, Gendre JP. Smoking cessation and the course of Crohn's disease: an intervention study. Gastroenterology. 2001;120(5):1093-9. Referans 13. Eliakim R, Fan QX, Babyatsky MW. Chronic nicotine administration differentially alters jejunal and colonic inflammation in interleukin-10 deficient mice. Eur J Gastroenterol Hepatol. 2002;14(6):607-14.
• Referans 14. Berkowitz L, Schultz BM, Salazar GA, Pardo-Roa C, Sebastian VP, Alvarez-Lobos MM, et al. Impact of Cigarette Smoking on the Gastrointestinal Tract Inflammation: Opposing Effects in Crohn's Disease and Ulcerative Colitis. Front Immunol. 2018;9:74.
• Referans 15. Ware JE, Jr., Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473-83.
• Referans 16. Kocyigit H. Reliability and validity of the Turkish version of short form-36 (SF-36): a study in a group of patients will rheumatic diseases. Turk J Drugs Ther. 1999;12:102-6.
• Referans 17. Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO. The Fagerstrom Test for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire. Br J Addict. 1991;86(9):1119-27.
• Referans 18. Uysal MA, Kadakal F, Karsidag C, Bayram NG, Uysal O, Yilmaz V. Fagerstrom test for nicotine dependence: reliability in a Turkish sample and factor analysis. Tuberk Toraks. 2004;52(2):115-21.
• Referans 19. Lunney PC, Kariyawasam VC, Wang RR, Middleton KL, Huang T, Selinger CP, et al. Smoking prevalence and its influence on disease course and surgery in Crohn's disease and ulcerative colitis. Aliment Pharmacol Ther. 2015;42(1):61-70.
• Referans 20. Lunney PC, Leong RW. Review article: Ulcerative colitis, smoking and nicotine therapy. Aliment Pharmacol Ther. 2012;36(11-12):997-1008.
• Referans 21. Beaugerie L, Massot N, Carbonnel F, Cattan S, Gendre JP, Cosnes J. Impact of cessation of smoking on the course of ulcerative colitis. Am J Gastroenterol. 2001;96(7):2113-6.
• Referans 22. Lashner BA, Hanauer SB, Silverstein MD. Testing nicotine gum for ulcerative colitis patients. Experience with single-patient trials. Dig Dis Sci. 1990;35(7):827-32.
• Referans 23. Benoni C, Nilsson Å. Smoking habits in patients with inflammatory bowel disease: a case-control study. Scandinavian journal of gastroenterology. 1987;22(9):1130-6.
• Referans 24. Medina C, Vergara M, Casellas F, Lara F, Naval J, Malagelada JR. Influence of the smoking habit in the surgery of inflammatory bowel disease. Rev Esp Enferm Dig. 1998;90(11):771-8.
• Referans 25. Moum B, Ekbom A, Vatn MH, Aadland E, Sauar J, Lygren I, et al. Clinical course during the 1st year after diagnosis in ulcerative colitis and Crohn's disease. Results of a large, prospective population-based study in southeastern Norway, 1990-93. Scand J Gastroenterol. 1997;32(10):1005-12.
• Referans 26. Somerville KW, Logan RF, Edmond M, Langman MJ. Smoking and Crohn's disease. Br Med J (Clin Res Ed). 1984;289(6450):954-6.
• Referans 27. Vedamurthy A, Ananthakrishnan AN. Influence of Environmental Factors in the Development and Outcomes of Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y). 2019;15(2):72-82.
• Referans 28. Lindberg E, Tysk C, Andersson K, Jarnerot G. Smoking and inflammatory bowel disease. A case control study. Gut. 1988;29(3):352-7.
• Referans 29. Bianchi Porro G, Panza E. Smoking, sugar, and inflammatory bowel disease. Br Med J (Clin Res Ed). 1985;291(6500):971-2.
• Referans 30. Johnson G, Cosnes J, Mansfield J. smoking cessation as primary therapy to modify the course of Crohn's disease. Alimentary pharmacology & therapeutics. 2005;21(8):921-31.
• Referans 31. Higuchi LM, Khalili H, Chan AT, Richter JM, Bousvaros A, Fuchs CS. A prospective study of cigarette smoking and the risk of inflammatory bowel disease in women. Am J Gastroenterol. 2012;107(9):1399-406.
• Referans 32. Seksik P, Nion-Larmurier I, Sokol H, Beaugerie L, Cosnes J. Effects of light smoking consumption on the clinical course of Crohn's disease. Inflamm Bowel Dis. 2009;15(5):734-41.
• Referans 33. Odes HS, Fich A, Reif S, Halak A, Lavy A, Keter D, et al. Effects of current cigarette smoking on clinical course of Crohn's disease and ulcerative colitis. Dig Dis Sci. 2001;46(8):1717-21.
• Referans 34. Nordin K, Pahlman L, Larsson K, Sundberg-Hjelm M, Loof L. Health-related quality of life and psychological distress in a population-based sample of Swedish patients with inflammatory bowel disease. Scand J Gastroenterol. 2002;37(4):450-7.
• Referans 35. Mukherjee S, Sloper P, Turnbull A. An insight into the experiences of parents with inflammatory bowel disease. Journal of Advanced Nursing. 2002;37(4):355-63.
• Referans 36. Quezada SM, Langenberg P, Cross RK. Cigarette smoking adversely affects disease activity and disease-specific quality of life in patients with Crohn’s disease at a tertiary referral center. Clinical and Experimental Gastroenterology. 2016;9:307.
• Referans 37. Guyatt G, Mitchell A, Irvine EJ, Singer J, Williams N, Goodacre R, et al. A new measure of health status for clinical trials in inflammatory bowel disease. Gastroenterology. 1989;96(3):804-10.
• Referans 38. Organization WH. Protection from exposure to second-hand tobacco smoke. World Health Organisation Geneva; 2007.
• Referans 39. van der Heide F, Dijkstra A, Albersnagel FA, Kleibeuker JH, Dijkstra G. Active and passive smoking behaviour and cessation plans of patients with Crohn's disease and ulcerative colitis. Journal of Crohn's and Colitis. 2010;4(2):125-31.
• Referans 40. Takagi T, Naito Y, Uchiyama K, Yoshikawa T. The role of heme oxygenase and carbon monoxide in inflammatory bowel disease. Redox Rep. 2010;15(5):193-201.
• Referans 41. Widbom L, Schneede J, Midttun Ø, Ueland PM, Karling P, Hultdin J. Elevated plasma cotinine is associated with an increased risk of developing IBD, especially among users of combusted tobacco. PloS one. 2020;15(7):e0235536.
• Referans 42. Pan K-T, Leonardi GS, Ucci M, Croxford B. Can exhaled carbon monoxide be used as a marker of exposure? A cross-sectional study in young adults. International journal of environmental research and public health. 2021;18(22):11893.
• Referans 43. Parkes GC, Whelan K, Lindsay JO. Smoking in inflammatory bowel disease: impact on disease course and insights into the aetiology of its effect. J Crohns Colitis. 2014;8(8):717-25.