Heat-Not-Burn Tobacco, E-Cigarettes May Be Linked to Postoperative Recurrence of Crohn Disease

TUESDAY, Aug. 18, 2026 (HealthDay News) — For patients with Crohn 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.

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.

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