For the next 2 weeks, our class will be discussing Inflammatory Bowel Disease (IBD). This week will revolve around media and review articles, and the paper I will be analyzing is "Smoking, Nicotine and Inflammatory Bowel Disease."
The article can be found at: http://ibdcrohns.about.com/cs/ibdfaqs/a/smokingguts.htm
Outside research article:
Before discussing the paper, it would be helpful to have a quick refresher on IBD.
- IBD involves chronic inflammation of all or part of the gastrointestinal tract.
- Etiology is unknown; however, IBD is thought to involve genetic, immunologic, and environmental factors.
- The most common inflammatory bowel diseases are Ulcerative Colitis and Crohn's disease.
- IBD is a chronic illness and there is currently no medical cure.
This paper primarily discusses smoking and its affects on Ulcerative Colitis (UC). Prior research has strongly indicated that non and ex-smokers are at an increased risk for developing UC, and a decreased risk of developing Crohn's disease. This indicates that smoking may actually be beneficial for delaying the onset of UC.
The author expands on this idea and explains that nicotine, a naturally occurring substance in tobacco, protects individuals against UC. According to a research article cited in the original paper, the exact protective mechanism(s) from nicotine are unknown; however, it is proposed that changes in intestinal motility, permeability, and colonic mucous are involved. Further studies involving nicotine were noted, but the protective effects against UC were accompanied with several negative symptoms.
Nonetheless, the risks of smoking far outweigh any possible benefit to a decreased risk of UC. Until the protective mechanism(s) of nicotine on UC are understood, it will be hard for pharmaceutical companies to formulate safe and effective medical interventions.
Outside research article:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2014383/
Nice overview, Andrew. I was very curious about the connection between smoking and inflammatory bowel disease, especially the seemingly protective effects of smoking on Ulcerative Colitis. I did a little bit of research and stumbled upon ihaveUC.com, a self proclaimed "International Community of people sharing stories about Ulcerative Colitis". I read some of the posts concerning smoking and was pretty shocked. Dr. Cohen pointed out in class that people might actually hold onto this small benefit of smoking even with all of the negative side effects. On this website, I found that to be true. For instance, AnonymousUC-er says, "Last Monday I went to see Dr. Hanauer at the University of Chicago. This guy is the bomb. Extremely positive and has experience that is out of the box. So, after reviewing my case, he flat told me to start smoking 3-5 cigarettes per day and I will be in remission faster than I have ever been. Yes, I am fully aware of all the side effects, but truth is, I started last Monday with 20-25 movements per day, and today I am down to 5!!!!! I am more willing to cut off a few years at the end if I have the quality of life until I get there."
ReplyDeleteFirst of all, it's hard to imagine a doctor actually telling a patient to start smoking. I'm going to guess there is a little more to the story than we are hearing. Second, this user brings up a good point in saying he acknowledges the risks but accepts the issues with smoking if they help his UC. If it really improves his quality of life (earlier he says he has uncontrollable bowel movements), and smoking truly helps him control this, is smoking worth it? Is the quality of life you gain from nicotine's effects on UC worth the negative impact of smoking? What do you guys think?
Here is the link to the website referenced: http://www.ihaveuc.com/does-smoking-really-help-ulcerative-colitis/
Wow, interesting stuff. I never would have thought a practicing physician would actually recommend a patient to START smoking! In their defense, the physician does make a good point in acknowledging the devastating impact IBD can have on suffering individuals. As long as the physician educates the patient in both types of intervention, I believe it is the patient's choice on what method they prefer. For this individual, it obviously sounds like their IBD is taxing both physically and mentally, and they are willing to do anything to decrease the symptoms. Nonetheless, it may sound like an easy decision to refuse smoking for therapeutic benefits; however, many of our decisions are made without actually experiencing the symptoms associated with IBD.
ReplyDeleteAlthough it may not be totally related this whole nicotine/smoking being helpful (in some ways) reminds me of the medical marijuana debate and even somewhat a little bit the euthanasia debate.
ReplyDeleteI think in this day and age we have many controversial medical treatments and some of the, haven't been fully explored or considered as prevalently due to harsh media criticism. Don't get me wrong smoking a blunt or pack a day doesn't exactly equate to ending your life when you deem it fit, but like Andrew said I think it's really up to the patient to determine how they want to live their lives. If they enjoy the benefits of a treatment knowing good and well it could hurt them even more than its helping them that's their choice to make. As health care providers and researchers its not their job to pick and chose which information is let out. If they tell both sides of the story making sure they've done everything in their power to weigh the pros and cons with the patient in the end it's the patients life. In my opinion all the researchers and physicians can do is present the information in the most unbiased way possible. Then the patients can make an informed decision about how they want to live their life, and if they deem they're living a miserable one and find solace in smoking a few cigs a day that's their choice and theirs alone.
Exactly that Cassie, it is the physician's job to inform the patient of the good and bad that come from certain interventions. Ultimately, it is the patient's decision. Regarding IBD, the symptoms seem to take both a physical and mental toll on suffering individuals so I can empathize with their decision to try treatments such as smoking or helminthes ingestion to soothe their symptoms.
ReplyDeleteThis article on nicotine use as a treatment option for Ulcerative Colitis (UC) fascinated me. I found it interesting that nicotine might be protective against one IBD disease, but not another (Crohn's Disease).
ReplyDeleteI read Julia's comment regarding a doctor that actually prescribed smoking as a treatment option to a patient with UC. The patient's symptoms were also said to improve with this treatment. We know that stress can be a major trigger in a UC episode. I was wondering if the actual physical act of smoking, and the therapeutic effects (regarding stress) from it might help relieve the symptoms of UC. If this were the case, I would wonder how much of his or her symptoms were relieved by the act of smoking and how much is actually due solely to the nicotine.
In addition, I was reading the outside research article Andrew provided: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2014383/. When I read this article I was startled to find that researchers were treating patients with nicotine enemas. The article says that "Administering nicotine in high doses topically into the colon might achieve therapeutic results with only a modest rise in serum nicotine, thus limiting the side-effectsof the substance". This idea shocked me, and I am not sure if I am the only one. One reason nicotine is dangerous because it can cause abnormal proliferation of epithelial cells. Abnormal proliferation of cells often leads to cancer. It seems to me that coating the lining of the rectum, and colon with nicotine that potentially could cause dysplasia and abnormal growth would be counterproductive. I would be greatly concerned that colorectal cancer would result instead. If research continues, I would like to see what the longterm effects of a nicotine enema might be.
This indicates that smoking may actually be beneficial for delaying the onset of UC.
ReplyDeleteThe author expands on cigarettes for sale this idea and explains that nicotine, a naturally occurring substance in tobacco, protects individuals against UC. According to a research article cited in the original paper,