S1779 Comparative Effects of Cigarette and Cannabis Smoking on Inflammatory Bowel Disease Complications and Outcomes: A Nationwide Analysis

Introduction: The impact of cigarettes and cannabis use on patients with inflammatory bowel disease (IBD) remains unclear, with conflicting evidence. With the growing legalization of cannabis, its use among IBD patients has increased. However, the effects of cannabis on IBD are still debated. While some studies suggest it may improve symptom control and promote remission, others fail to show clear benefits. This study aims to provide more information regarding the relationship between cigarettes and cannabis smoking in IBD-related outcomes. Methods: We analyzed patients aged 18 years or older with IBD or related complications from 2016 to 2021 using the National Inpatient Sample database and International Classification of Diseases-10 codes. Patients were grouped by nicotine and cannabis use. Survey-weighted methods accounted for stratified sampling. Survey statistical methods, accounting for strata and weighted data, were utilized for analysis. Categorical and continuous variables were compared using Roa-Scott chi-square and Student’s t-tests, respectively. Composite IBD complications were assessed via univariate and multivariate regression, including covariates with P < 0.1; significance was set at P < 0.05. Data were extracted with Python (v3.9.1) and analyzed in R (v3.6.2) using the survey package. Results: A total of 189,796 patients were included: 155,466 nonsmokers, 28,295 nicotine smokers, 3,365 cannabis smokers, and 2,670 dual users. Complications assessed include pouchitis, toxic megacolon, abscess, obstruction, and others. In ulcerative colitis, cannabis users had lower odds of complications than nonsmokers and smokers (odds ratio [OR] 0.97, P < 0.01). Cigarette smokers had shorter hospital stays than nonsmokers (length of stay [LOS]: 4.20 ± 4.31 vs 4.55 ± 5.01, P < 0.01). In Crohn's disease, cannabis and dual users had fewer complications than smokers (OR 0.94, P < 0.01), but cannabis users had longer hospital stays than both nonsmokers and cigarette smokers (P < 0.01). Conclusion: These results raise questions about the true impact of smoking on IBD. Despite cannabis smoking showing lower odds of complications in IBD, the differences in LOS between Crohn’s disease and ulcerative colitis highlight the need for further investigation. As cannabis use increases post-legalization, understanding its combined effects with nicotine on IBD is crucial for evaluating disease progression and outcomes.