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Impact of Cigarette Smoking on the Gastrointestinal Tract Inflammation: Opposing Effects in Crohn's Disease and Ulcerative Colitis

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Review

Impact of Cigarette Smoking on the Gastrointestinal Tract Inflammation: Opposing Effects in Crohn's Disease and Ulcerative Colitis

Loni Berkowitz et al. Front Immunol.

Abstract

Cigarette smoking is a major risk factor for gastrointestinal disorders, such as peptic ulcer, Crohn's disease (CD), and several cancers. The mechanisms proposed to explain the role of smoking in these disorders include mucosal damage, changes in gut irrigation, and impaired mucosal immune response. Paradoxically, cigarette smoking is a protective factor for the development and progression of ulcerative colitis (UC). UC and CD represent the two most important conditions of inflammatory bowel diseases, and share several clinical features. The opposite effects of smoking on these two conditions have been a topic of great interest in the last 30 years, and has not yet been clarified. In this review, we summarize the most important and well-understood effects of smoking in the gastrointestinal tract; and particularly, in intestinal inflammation, discussing available studies that have addressed the causes that would explain the opposite effects of smoking in CD and UC.

Keywords: Crohn’s disease; cigarette smoking; gastrointestinal inflammation; inflammatory bowel disease; ulcerative colitis.

Figures

Figure 1
Figure 1
Effects of cigarette smoking on Crohn’s ileitis. A high percentage of particulate matter may reach the ileum, where it could alter the interaction of the intestinal mucosa with the microbiota through several mechanisms, e.g., affecting bacterial clearance, changing microbiota composition, increasing the permeability of the intestinal barrier, and disregulating immune responses. These alterations could prevail over the immunomodulatory effects of carbon monoxide and nicotine. Purple text denotes described effects and red text denotes proposed effects.
Figure 2
Figure 2
Impact of cigarette components on ulcerative colitis (UC). The distal segment of the large intestine could be mainly affected by the circulating components, where both carbon monoxide and nicotine could modulate the inflammatory profile, autoantibodies production, and leukocyte migration. These immunomodulatory effects could prevail in UC over the harmful effects observed in ileal Crohn’s disease, probably due to the lower arrival of luminal components and to the etiological differences between both disorders. Purple text denotes described effects and red text denotes proposed effects.

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