Effect of ulcerative colitis and smoking on rectal blood flow

Article Abstract:

Ulcerative colitis is a condition in which the colon (the lower part of the intestinal tract) is inflamed, causing diarrhea, pain, and the possibility of complete perforation of the wall of the colon that can be fatal. The cause of this disease is not known, but it is more prevalent in nonsmokers and former smokers than in patients who smoke. To ascertain the effect of smoking on blood flow to the colon and rectum (which could play a role in development of ulcerative colitis), a study was performed with eight nonsmoking patients who were being treated for ulcerative colitis, and with 10 healthy control subjects who were either smokers or nonsmokers. Rectal blood flow was measured by laser Doppler flowmetry over a 60-minute period. In all patients, blood flow decreased over the measurement period. Ulcerative colitis patients had significantly higher levels of rectal blood flow, and the levels remained higher than those recorded for the healthy controls for the entire period. In the control population, rectal blood flow was similar for smokers and nonsmokers. When the smokers were allowed to smoke, this was associated with a significant fall in rectal blood flow that was correlated with the magnitude of the increase seen in plasma nicotine levels. Lower levels of rectal blood flow occur in healthy individuals than in those suffering from ulcerative colitis. Smoking seems to confer a protective advantage against ulcerative colitis by reducing rectal blood flow (which may be a mechanism involved in the disease). (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Physiological aspects, Physiological regulation, Tobacco, Regional blood flow

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Screening for colorectal cancer in ulcerative colitis: dubious benefits and high costs

Article Abstract:

Ulcerative colitis is an inflammatory condition of the colon. In some instances, abnormal colon tissue associated with ulcerative colitis can become cancerous. Consequently, it has become routine to screen ulcerative colitis patients for colon cancer by means of colonoscopy (introducing a fiber optic viewing device into the colon) and multiple biopsies (removal of colonic tissue for microscopic and biochemical analysis). Before the cost, risks, and inconvenience to the patient of screening can be justified, it must be proven that screening will identify colonic cancer earlier and that, as a group, patients who undergo screening will live longer than those who do not. When the results of three published reports on colonoscopic screening for colorectal cancer were reviewed, very limited patient benefit was found to have been derived from colonoscopic screening of patients with ulcerative colitis; the large majority of cancers that were discovered would have been discovered by routine clinical care with little or no delay in the time of discovery. It is concluded that, given the limited resources that are allocated to health care as a whole, funds and personnel would be put to better use elsewhere. A more efficient predictor of colonic cancer is needed; the colonoscopy procedure with multiple biopsies has limited value and should be discontinued. However, at the present time, alternative markers for cancer, such as mucous quality and staining patterns of colonic cells, do not yet offer a suitable replacement. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reports, Diagnosis, Complications and side effects, Colorectal cancer, Colonoscopy, Medical screening, Health screening

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Inflammatory bowel disease and tobacco smoke: a case-control study

Article Abstract:

Inflammatory bowel disease (IBD) is a general term for inflammation of the ileum (Crohn's disease) or colon (ulcerative colitis) resulting in pain, malabsorption of nutrients, diarrhea, bleeding, and other symptoms. The causal factors involved in the onset of IBD are not known, but it is thought that many environmental conditions may increase or decrease the likelihood of developing this disease. Cigarette smoking has been linked to the development of IBD, but the data are contradictory and confusing. Cigarette smokers are reported to be more likely to develop Crohn's disease than nonsmokers, but less likely to develop ulcerative colitis than nonsmokers. To further investigate the relationship between smoking and IBD, a case-control study was carried out in Sweden, between 1984 and 1987, which examined the influence of smoking and of childhood exposure to cigarette smoke on the prevalence of IBD. Information was collected using questionnaires completed by 152 Crohn's disease patients, 145 ulcerative colitis patients, and 305 respondents with no diagnosed gastrointestinal disease. The risk of developing Crohn's disease was greater in patients who had been exposed to cigarette smoke as children; there was no effect of childhood environmental smoke on predilection towards ulcerative colitis. The risk of developing ulcerative colitis was greater in smokers who had recently quit than it was in patients who had never smoked. Data on additional subgroups are also reported and discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Inflammatory bowel diseases, Crohn's disease

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