The Impact of E-Cigarettes and Heat-Not-Burn Tobacco on Postoperative Recurrence of Crohn's Disease: A Multicenter International Study
Bibliographic record
Abstract
INTRODUCTION: Tobacco smoke is an established risk factor of Crohn's disease (CD) postoperative recurrence; however, the effect of e-cigarettes and heat-not-burn tobacco (HNBT) remains unknown. We aimed to evaluate the impact of e-cigarettes and HNBT on postoperative recurrence in patients with CD. METHODS: We retrospectively included consecutive patients with CD who underwent ileocolic resection and endoscopic evaluation within 1 year across 9 centers in Italy, Spain, and France. Based on smoking habits between surgery and endoscopy, patients were categorized as nonsmokers, cigarette smokers, HNBT users, or e-cigarette users. Those using multiple products were excluded. The primary outcome was endoscopic recurrence (Rutgeerts score ≥2) 1 year after surgery. Secondary analyses included modified Rutgeerts score (≥i2b), mean Rutgeerts score, transmural disease activity, fecal calprotectin, time from diagnosis to surgery, and uni- and multivariable regression analysis. RESULTS: Nine hundred thirty-seven patients were included, of which 691 (74%) were nonsmokers, 176 (19%) conventional cigarette smokers, 37 (4%) HNBT users, and 33 (4%) e-cigarette users. Recurrence rates were significantly higher in all smoking groups compared with nonsmokers (69.4%, 63.9%, and 60.6% for traditional cigarette, HNBT, and e-cigarette users, respectively, vs 40.8% for non-smokers; all P < 0.05). The association was also observed in patients receiving pharmacological prophylaxis, using the modified Rutgeerts score cutoff of i2b, mean Rutgeerts score, and fecal calprotectin levels. In multivariable regression analysis, HNBT use remained significantly associated with recurrence (odds ratio [OR] 2.76), whereas the association for e-cigarette missed statistical significance (OR 2.02, P = 0.067). DISCUSSION: HNBT, and possibly e-cigarettes, are associated with increased endoscopic recurrence of CD compared with nonsmoking.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".