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* = Presenting author

P409 Smoking is associated with extra-intestinal manifestations in inflammatory bowel disease

M. Severs*1, S. van Erp2, G. Dijkstra3, M.E. van der Valk1, M.-J. Mangen4, M. van der Have1, A.A. van Bodegraven5, 6, H.H. Fidder1, D.J. de Jong7, M. Pierik8, J. van der Woude9, M.J.L. Romberg- Camps5, C.H.M. Clemens10, J.M. Jansen11, P.C. van de Meeberg12, N. Mahmmod13, C.Y. Ponsioen14, C.J. Bolwerk15, J.R. Vermeijden16, P.D. Siersema1, M. Leenders1, A.E van der Meulen- de Jong2, B. Oldenburg1

1University Medical Centre Utrecht, Gastroenterology and Hepatology, Utrecht, Netherlands, 2Leiden University Medical Centre, Gastroenterology and Hepatology, Leiden, Netherlands, 3University Medical Centre Groningen, Gastroenterology and Hepatology, Groningen, Netherlands, 4University Medical Centre Utrecht, Julius center for health sciences and primary care, Utrecht, Netherlands, 5ORBIS medical center, Gastroenterology and Hepatology, Sittard, Netherlands, 6VU medical center, Gastroenterology and Hepatology, Amsterdam, Netherlands, 7University Medical Center st. Radboud, Gastroenterology and Hepatology, Nijmegen, Netherlands, 8University Medical Center Maastricht, Gastroenterology and Hepatology, Maastricht, Netherlands, 9Erasmus Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands, 10Diaconessenhuis, Gastroenterology and Hepatology, Leiden, Netherlands, 11Onze Lieve Vrouwe Gasthuis, Gastroenterology and Hepatology, Amsterdam, Netherlands, 12Slingeland Hospital, Gastroenterology and Hepatology, Doetinchem, Netherlands, 13Antonius Hospital, Gastroenterology and Hepatology, Nieuwegein, Netherlands, 14Academic Medical Centre Amsterdam, Gastroenterology and Hepatology, Amsterdam, Netherlands, 15Reinier de Graaf Groep, Gastroenterology and Hepatology, Delft, Netherlands, 16Meander Medical Centre, Gastroenterology and Hepatology, Amersfoort, Netherlands


Smoking influences the disease activity in inflammatory bowel disease (IBD). We aimed to study the association between smoking and extra- intestinal manifestations (EIMs) in IBD.


The association between smoking and EIMs such as joint complaints, chronic skin disorders and eye complaints was investigated in three cohorts. The COIN- study is a large prospective cohort study with data collected by questionnaires about demographics, disease course and associated cost items. In the Groningen cohort, questionnaires on cigarette smoke exposure and disease behaviour in IBD patients were collected. The JOINT- study is a prospective longitudinal study focused on IBD patients with and without back pain and peripheral joint complaints. A putative dose-response relationship between smoking and EIMs, and the association between smoking and specific phenotypes of arthropathies was explored.


In the COIN study, 3,030 patients (1,558 Crohn's disease (CD), 1,054 ulcerative colitis (UC) and 418 IBD-unspecified) were enrolled; 16.0% were current smokers. In the Groningen cohort, 780 IBD patients (420 CD, 298 UC, 62 IBD-unspecified) were included; 23.6% were current smokers. In the JOINT study, 255 patients (186 CD, 69 UC) were enrolled; 23.5% were current smokers. EIMs were significantly more prevalent in the smoking IBD population (COIN: 39.1% vs. 29.8%, p <0.001 and Groningen: 42.8% vs. 31.2%, p <0.001). This association was more pronounced in CD than in UC. Joint complaints were the most prevalent EIM in both CD and UC. Of all EIMs, smoking appeared to have the most significant association with joint complaints (COIN: CD 30.7% vs. 22.1%, p <0.001, UC 25.3% vs. 18.5%, p =0.11 and Groningen: CD 46.4% vs. 40.4%, p =0.26, UC 31.0% vs. 23.0%, p =0.34). Likewise, in the JOINT study, smoking was more prevalent in IBD patients with artropathies (30.3% s. 13%, p =0.001). A dose-response relationship is suggested by the fact that EIMs were more prevalent in heavy smoking patients compared to low exposure smokers (56.0% vs. 37.1%, p =0.10). Smoking was not associated with a specific phenotype of spondylarthropathy.


The results of three cohort studies confirm a positive association between smoking and extra-intestinal manifestations in IBD. This association appears to be subject to a dose-response effect.