Clinical status of ulcerative colitis in patients who smoke

Am J Gastroenterol. 1998 Sep;93(9):1463-7. doi: 10.1111/j.1572-0241.1998.00464.x.


Objectives: Ulcerative colitis (UC) is largely a disease of nonsmokers. There are few patients who are current smokers, but we have identified a group and reviewed their clinical status, disease activity, and nicotine exposure to examine whether they remain well controlled while smoking.

Methods: Fifty-one patients from three centers with verified UC were reviewed.

Results: Thirty of the group were men; mean age 50 yr, with a mean age of onset of 37 yr. Twenty-two patients had proctosigmoid disease, 12 involvement of left colon, and 17 total colitis. All were current smokers; 41 were cigarette smokers averaging 17 daily. At the onset of colitis 30 were nonsmokers, 25 of them were ex-smokers and 19 developed colitis within 2 yr of stopping smoking. Twenty-eight believed smoking improved disease activity and none felt smoking had a detrimental effect on their UC. Eleven were receiving no medication for UC, 40 were receiving 5-ASA (5-aminosalicylic acid) preparations, and only two took oral steroids. All were in clinical remission, with the exception of one patient; mean St. Marks score was 1.5, out of a possible total of 22. Sigmoidoscopic grades were inactive in all patients except three. Histological assessment showed significant activity in only five. Median serum nicotine was 8 ng/ml (range, 0.4-24.4), median serum cotinine 180 ng/ml (range, 20-453), with corresponding salivary cotinine of 255 ng/ml (range, 34-683). Median rise in nicotine 2 min after a cigarette in 35 patients was 12.1 ng/ml (range, 0.4-44).

Conclusions: Because most current smokers with UC have inactive disease, smoking may contribute to the clinical remission in these patients.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Colitis, Ulcerative / blood
  • Colitis, Ulcerative / complications*
  • Colitis, Ulcerative / drug therapy
  • Colitis, Ulcerative / prevention & control
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nicotine / blood
  • Retrospective Studies
  • Severity of Illness Index
  • Sigmoidoscopy
  • Smoking / adverse effects*
  • Smoking / blood
  • Smoking Cessation
  • United Kingdom


  • Nicotine