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* = Presenting author

P171 Smoking is associated with watery diarrhea and decreased likelihood to achieve clinical remission in collagenous colitis

A. Münch*1, J. Bohr2, A. Madisch3, O. Bonderup4, C. Tysk5, M. Ström6, R. Mohrbacher7, R. Mueller7, R. Greinwald7, S. Miehlke8

1University hospital, Gastroenterology, Linköping, Sweden, 2University hospital, Gastroenterology, Örebro, Sweden, 3Siloah Hospital, Medical Department I, Hannover, Germany, 4Regional Hospital, Gastroenterology, Silkeborg, Sweden, 5University Hospital, Gastoenterology and Hepatology, Örebro, Sweden, 6Univeristy hospital, Gastroenterology, Linköping, Sweden, 7Dr. Falk Pharma, Research, Freiburg, Germany, 8Center for Digestive Diseases, Internal Medicine, Hamburg, Germany

Background

Smoking seems to be a risk factor for microscopic colitis and smokers develop the disease more than 10 years earlier than non-smokers. However, the impact of smoking on clinical activity and outcome has not been elucidated.

Methods

In a post-hoc analysis from pooled data of two randomized controlled trials (BUC-60/COC and BUC-63/COC) we assessed the association of demographical (gender, age, smoking habits, previous and/or concomitant medication, family history of inflammatory bowel disease) and clinical variables (duration of symptoms, mean number of stools/watery stools per day, abdominal pain, clinical remission). Moreover, we analyzed the predictive value of baseline parameters on clinical outcome in a logistic regression model.

Results

Pooled data from 202 patients with active collagenous colitis (CC) were available thereof 36% current smokers, 29% former smokers and 35% non-smokers. Current smokers had an increased number of watery stools at baseline compared to non-smokers (p=0.05). 20/137 (15%) patients treated with budesonide did not achieve clinical remission. The majority of these (85%) were either smokers or former smokers. An association was found between smoking status (current smokers vs. non smokers: OR 0.37, 95% CI: 0.14-0.96, p=0.041; former smokers vs. non smokers: OR 0.21, 95% CI: 0.07-0.60, p=0.004), mean number of watery stools per day (OR 0.77, 95% CI: 0.66-0.90, p=0.001) and decreased likelihood to obtain clinical remission. All other variables showed no significant association.

Conclusion

Smoking is associated with increased number of watery stools and decreased likelihood to achieve clinical remission in collagenous colitis. Smoking seems to have an impact on disease activity and treatment outcome in patients with CC.