Heated tobacco and electronic cigarettes are associated with an increased risk of Crohn's disease recurrence

An international study published in The American Journal of Gastroenterology suggests that the use of heated tobacco and electronic cigarettes increases the risk of postoperative recurrence in people with Crohn's disease[1]. The link appears particularly marked for heated tobacco, the link between conventional tobacco and a more frequent and severe form of Crohn's disease having been known for a long time, while the results concerning electronic cigarettes remain to be confirmed.

A study conducted in nine European centers

Researchers retrospectively analyzed data from 937 patients who underwent ileocolonic resection followed by endoscopic evaluation within one year of the procedure. Participants, followed at nine centers in France, Italy, and Spain, were categorized according to their tobacco or nicotine use: non-smokers, conventional cigarette smokers, heated tobacco users, and e-cigarette users. To limit bias, individuals using multiple products or who switched products during the postoperative period were excluded. The primary outcome was endoscopic recurrence, defined as a Rutgeerts score of 2 or higher.

Highest recidivism rates among tobacco users

Endoscopic recurrence was observed in 40.8% of non-smokers, compared to 69.4% of conventional cigarette smokers, 63.9% of heated tobacco users, and 60.6% of e-cigarette users. These differences remained significant in patients who received prophylactic treatment after surgery. After accounting for several potentially confounding factors, conventional smoking remained associated with an increased risk of recurrence, with an odds ratio of 3.49. Heated tobacco was also significantly associated with this risk, with an odds ratio of 2.76. For e-cigarettes, the observed association—odds ratio of 2.02—did not reach statistical significance.

Additional indicators pointed in the same direction. Smokers of conventional tobacco and heated tobacco had higher levels of fecal calprotectin than non-smokers, and levels in electronic cigarette users were intermediate.

These results should be interpreted with caution, but they are consistent with the precautionary principle.

The authors emphasize that this is the first study dedicated to the impact of heated tobacco and e-cigarettes on postoperative recurrence of Crohn's disease. They propose several biological hypotheses, including the possible role of nicotine or other substances common to the different products. However, the study has several limitations: the groups of heated tobacco and e-cigarette users were small, the vaping products were highly heterogeneous, and consumption habits may have been underreported. Its retrospective nature also prevents the establishment of a causal link. Nevertheless, the researchers believe that these products should not be considered risk-free for patients who have undergone surgery for Crohn's disease. They recommend maintaining complete smoking cessation as the primary objective and suggest that e-cigarette and heated tobacco users be monitored with the same level of vigilance as traditional smokers in postoperative follow-up.

As a reminder, no independent study has demonstrated that heated tobacco products, which are tobacco products just like cigarettes, lead to any reduction in risks for smokers. Therefore, it is necessary that heated tobacco be subject to regulations and taxation comparable to those of traditional cigarettes. Similarly, even if e-cigarettes present fewer risks than those associated with tobacco in all its forms, risks are already proven: disorders respiratory, Cardiovascular and neurological effects, as well as potential effects on fetal development in pregnant women, are also noted. The long-term risks of using these products remain largely unknown.

©Generation Without Tobacco

AD

[1]Tommaso Lorenzo Parigi et al., The Impact of E-Cigarettes and Heat-Not-Burn Tobacco on Postoperative Recurrence of Crohn's Disease: A Multicenter International Study, American Journal of Gastroenterology, 121(8), 1954–1962, published October 24, 2025, accessed August 19, 2026

National Committee Against Smoking |