HOT OFF THE PRESSES: TOBACCO CESSATION AND PROTON PUMP INHIBITORS
Patients with Ulcerative Colitis (UC) and Crohn’s disease should NOT SMOKE TOBACCO. While this may seem obvious-nearly everyone knows you should not use tobacco products because of heart, lung, cancer and stroke risks, it is even more important not to smoke with Crohn’s disease. Crohn’s disease patients who smoke HAVE MORE complications, require more operations, and require steroids and immune-suppressant medications more often.
Stopping smoking reduces the frequency of Crohn’s disease flares by 65%!
There is even evidence that second-hand smoke exposure (from other members of the household) can make Crohn’s worse for non-smoking patients. Cutting down on smoking is not enough. Crohn’s patients must quit to benefit.
The considerations in Ulcerative Colitis used to be more complicated. Although tobacco smoke exposure is associated with a MUCH HIGHER RISK of developing UC, there was some controversy about whether or not active smokers with UC had a reduced risk of needing surgery, hospitalizations, immune suppressant medications, and corticosteroids.
Many patients with UC are even aware of what was even thought to be a ‘protective effect’ from tobacco smoking. Others were even told by their health care professionals not to stop smoking, particularly if their UC was hard to control. This advice generally came from small studies or did not represent large populations. Some small studies even showed that nicotine patches alone can help settle a disease flare, but they were not useful in keeping patients well and many patients had to stop using the patches much more often because of side effects.
Now, HOT OFF THE PRESSES, a large, 12-year long study of almost 6800 patients was just published showing that smoking was NOT IN ANY WAY protective in Ulcerative Colitis. Smoking cessation was NOT associated with a worse disease course, more disease flares, more complications, or a higher need for surgery or corticosteroids. The greater health risks associated with smoking outweigh any benefits. Like patients with Crohn’s disease, Ulcerative Colitis patients should STOP SMOKING.
The health care professionals at Greater Boston GI are happy to work with you and your primary care patients to help you stop.
PROTON PUMP INHIBITORS (PPI’s)
There has been a lot of sensationalized coverage in the lay press over the last few years about whether or not Proton Pump Inhibitors like omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid) and pantoprazole (Pantoprazole) caused an increased risk of bone fractures, kidney disease, dementia, heart disease, stomach cancer, or even mortality rates. Because of these reports, many patients either stopped these medications on their own or were told to stop them by their primary care physicians. Predictably, nearly everyone developed their GI symptoms or problems all over again.
The doctors and nurse practitioners at Greater Boston GI have counseled that these risks WERE NOT SUBSTANTIATED by good studies and SHOULD NOT PROMPT DISCONTINUATION or taper of these pills. This was particularly important since many of our patients have sound indications for strong acid suppression-chest pain syndromes, swallowing disorders, severe acid reflux (GERD) symptoms, erosive esophagus damage, peptic-acid esophagus strictures, biopsy-proven Barrett’s esophagus, peptic ulcer treatment, high Peptic Ulcer Disease risk, or serious complications in patients on aspirin or other anti-inflammatory medications (NSAIDs) like bleeding. Still, some patients and PCP’s were hesitant to take our advice.
Turns out, WE WERE RIGHT.
Now, HOT OFF THE PRESSES, in the largest study of patients on Proton Pump Inhibitors (PPI’s) ever published, 17,000 patients were followed prospectively for 3-5 years and showed NO INCREASED RISK of these adverse events. Like all medication, the use of PPI’s should be limited to appropriate indications and when the benefits outweigh the risks. However, limiting the prescription or use of these medications simply because of concerns of long-term harm is not appropriate. Keep taking your medications as prescribed.