Heat-Not-Burn Tobacco Products May Increase Postoperative Crohn’s Disease Recurrence Risk

For patients with Crohn’s disease (CD), heat-not-burn tobacco (HNBT) and possibly electronic cigarette (e-cigarette) use is associated with increased postoperative endoscopic recurrence of CD, according to a study published in the August issue of the American Journal of Gastroenterology.

How Was the Study Conducted?

Tommaso Lorenzo Parigi, M.D., from IRCCS Ospedale San Raffaele in Milan, and colleagues examined the impact of e-cigarettes and HNBT on postoperative recurrence in patients with CD. Consecutive patients with CD who underwent ileocolic resection and endoscopic evaluation within one year were retrospectively included. Patients were classified as nonsmokers, cigarette smokers, HNBT users, or e-cigarette users; those using multiple products were excluded. Endoscopic recurrence (Rutgeerts score ≥2) at one year after surgery was measured as the primary outcome.

A total of 937 patients were included: 74 percent nonsmokers, 19 percent conventional cigarette smokers, 4 percent HNBT users, and 4 percent e-cigarette users. The researchers found that compared with nonsmokers, all smoking groups had significantly higher recurrence rates (69.4, 63.9, and 60.6 percent versus 40.8 percent for traditional cigarette, HNBT, and e-cigarette users versus nonsmokers, respectively). Using the modified Rutgeerts score cutoff of i2b, mean Rutgeerts score, and fecal calprotectin levels, the association was also observed in patients receiving pharmacological prophylaxis. HNBT use remained significantly associated with recurrence in a multivariable regression analysis, while the association for e-cigarettes was not statistically significant.

“Based on these observations, we suggest that patients with CD using e-cigarettes or HNBT be managed similarly to traditional smokers in the postoperative setting,” the authors write.

Where This Research Fits Into Existing Smoking Guidance for Crohn’s Disease

Traditional cigarette smoking is one of the most established modifiable risk factors for Crohn’s disease progression and postoperative recurrence. Some CD patients receive heated tobacco products and e-cigarettes as safer alternatives.

This latest study suggests clinicians should be cautious about recommending or implicitly endorsing these products until more evidence is available. The findings suggest that harm reduction may not reduce Crohn’s-related risk for some patients.

From our partner

Expert Videos: Learn how early UACR testing can help reveal hidden CKD and related cardiovascular risk, even when eGFR appears normal.

Counseling Patients About Alternative Nicotine Products After Surgery

Smoking and nicotine can worsen Crohn’s disease, increasing disease severity, flare-ups, complications, and the need for surgery. Many patients may turn to heated tobacco products after surgery with the belief that they are less harmful. However, the latest research shows that HNBT shouldn’t be considered safe or risk-free substitutes for traditional cigarettes.

During routine visits, clinicians should ask patients about HNBT products, including:

• E-cigarette use
• Nicotine pouches
• Vapes
• Dual use of multiple nicotine products

Discussions about smoking cessation may need to be updated to include newer tobacco products. Full tobacco and nicotine cessation remains the primary recommendation for improving long-term outcomes and reducing flare or recurrence risks.

From our partner

Vitiligo doesn’t have to keep you down - Find out how the FPAD clinical trial may help!

What This May Mean for Black Patients With Crohn’s Disease

Crohn’s disease has historically been diagnosed less frequently in Black patients than in white patients. However, incidence rates are now rising, and Black patients often experience distinct clinical presentations, diagnostic delays, barriers to specialty care, and higher rates of complications.

Because smoking is a modifiable risk factor for the gastrointestinal disorder, identifying all forms of nicotine use may be especially important for patient populations already facing barriers to optimal treatment.

With this in mind, clinicians should ensure culturally responsive smoking cessation counseling and access to evidence-based cessation resources.

The Need for More Diverse Research in Crohn’s Disease

Many inflammatory bowel disease (IBD) studies continue to underrepresent Black patients and other minority populations. Current evidence doesn’t reveal whether heated tobacco products and postoperative recurrence differ across racial and ethnic groups. Future studies should prioritize more diverse participant populations to improve generalizability. This is especially important for Black patients, who have been historically underrepresented in clinical trials across many illnesses and diseases.

Key Takeaways for Clinicians

• Patients who use heat-not-burn tobacco products after Crohn’s disease surgery may face a higher risk of postoperative disease recurrence, raising concerns about these products as alternatives to traditional cigarettes.
• The findings challenge the perception that HNBT products are a “safer” option for patients with Crohn’s disease, particularly during the postoperative period.
• Providers should expand tobacco-use assessments beyond conventional cigarette smoking to include heated tobacco products, e-cigarettes, and other emerging nicotine delivery systems.
• Smoking cessation counseling remains a critical component of postoperative Crohn’s disease management, regardless of the type of nicotine product used.
• As Crohn’s disease diagnoses continue to rise among Black Americans, identifying modifiable risk factors such as tobacco and nicotine use may help improve long-term disease outcomes and reduce recurrence risk.
• Additional research is needed to determine whether these findings extend to more diverse patient populations, including Black patients who remain underrepresented in many inflammatory bowel disease studies.

Abstract/Full Text

Are you a healthcare professional? Register with us today!