DEAR MAYO CLINIC:

When I quit smoking cigarettes four years ago, I discovered I have ulcerative colitis. After a few years of only moderate success treating it with medication, I started wearing a nicotine patch. My improvement was profound. Have there been any recent studies on this correlation? What information is available about long-term use of nicotine patches?

ANSWER:

Research has shown an association between cigarette smoking and ulcerative colitis. Studies have found that smoking seems to provide short-term relief from ulcerative colitis symptoms. Based on those findings, doctors may recommend nicotine patches for some people to rein in ulcerative colitis flare-ups. But for long-term symptom control, this treatment doesn't appear to be effective, and it's not appropriate for everyone.

Ulcerative colitis is a form of inflammatory bowel disease that causes chronic inflammation of the digestive tract. Usually, only the innermost lining of the colon and rectum is affected. Symptoms of ulcerative colitis can vary, depending on the severity of the inflammation and where it occurs within the colon and rectum. Some common symptoms include diarrhea, abdominal pain and cramping, and fatigue. Typically, symptoms of ulcerative colitis come and go, with active periods of acute illness often alternating with periods of symptom-free remission.

Researchers believe that some people who have inflammatory bowel disease develop the condition because of an abnormal immune response. Environmental factors appear to have a role in development of the disease, as well. The strongest evidence for an environmental factor has been the relationship between cigarette smoking and inflammatory bowel disease.

Several studies that reviewed the incidence, distribution and factors contributing to the disease have suggested that cigarette smoking protects people from ulcerative colitis disease activity. On the other hand, cigarette smoking appears to worsen Crohn's disease, another form of inflammatory bowel disease. Researchers have not proven an explanation for these findings, but they presume that nicotine and other products in cigarette smoke may affect the digestive tract's immune response.

Of course, the overall health risks from smoking far outweigh any potential benefit that nicotine might provide, so no one should begin smoking to treat ulcerative colitis. However, clinical trials using transdermal nicotine patches suggest that use of the patches can improve ulcerative colitis-associated symptoms. Nicotine therapy may be of particular benefit for people like you who developed ulcerative colitis when they stopped smoking.

While nicotine therapy appears to offer some benefit in people with active ulcerative colitis, one study suggests that it's not effective for maintaining remission. Thus, nicotine may be used to bring some patients with active disease into remission. To keep symptoms under control, though, patients likely would then require additional maintenance therapy, such as anti-inflammatory medications and drugs that work to suppress the immune system.

I suggest you talk to your doctor about the appropriate use of nicotine patches in your situation and discuss how they fit into your long-term treatment plan for ulcerative colitis.

-- Jonathan Leighton, M.D., Gastroenterology/Hepatology, Mayo Clinic, Scottsdale, Ariz.

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