WBR0569

Author	[[PageAuthor::Yazan Daaboul, M.D., (Reviewed by Alison Leibowitz [1] and Yazan Daaboul, M.D.)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Gastrointestinal
Prompt	[[Prompt::A 25-year-old man presents to the physician's office with complaints of bloody diarrhea and abdominal pain for the past 2 weeks. The patient explains that he consumes a high-fat, low-starch diet and has a sedentary lifestyle. Initial work-up reveals loss of haustra on abdominal x-ray. Endoscopy shows formation of pseudopolyps, and biopsies of the GI tract show mucosal and submucosal inflammation in the colon that involve the rectum. Which of the following factors plays a protective role against the patient's condition?]]
Answer A	AnswerA::Caucasian race
Answer A Explanation	[[AnswerAExp::Caucasian race is considered a risk factor for ulcerative colitis.]]
Answer B	AnswerB::High-fat, low-starch diet
Answer B Explanation	[[AnswerBExp::A high fat diet is considered a risk factor for ulcerative colitis.]]
Answer C	AnswerC::Sedentary lifestyle
Answer C Explanation	[[AnswerCExp::Sedentary lifestyle may be a risk factor for the development of ulcerative colitis. In contrast, exercise is considered protective against ulcerative colitis.]]
Answer D	AnswerD::Active cigarette smoking
Answer D Explanation	[[AnswerDExp::Active cigarette smoking is presumed to have a protective role against ulcerative colitis, disease course, and rates of hospitalizations and flare-ups.]]
Answer E	AnswerE::Alcohol consumption
Answer E Explanation	[[AnswerEExp::Alcohol consumption is considered a risk factor for ulcerative colitis.]]
Right Answer	RightAnswer::D
Explanation	[[Explanation::Ulcerative colitis (UC) is an inflammatory bowel disease characterized by mucosal and submucosal inflammation of the colon that almost always involves the rectum. Risk factors associated with UC include genetic elements, such as Caucasian race and positive family history, and environmental factors, such as high fat diet, sedentary lifestyle, alcohol consumption. In contrast, appendectomy and smoking have been demonstrated to be protective against UC. The relationship between smoking and UC has been studied for more than 30 years; active smoking was demonstrated to be associated with a decreased risk of developing UC, a more benign course, and less hospitalizations and flare-ups among patients with ulcerative colitis. Nicotine is believed to be the protective ingredient of cigarettes because it is thought to induce the synthesis of mucin in the colon and reduce the concentration of secretory IgA, the macrophage phagocytic activity, and the cytokine secretion in the GI tract. Nicotine is currently studied as a therapeutic option for patients with UC in the forms of nicotine gum, transdermal patch, delayed release oral capsule, and enema. In contrast, ex-smoking did not demonstrate to have the same protective effect as active smoking and may in fact be associated with worse disease course in patients with UC. Nonetheless, smoking is associated with significant deleterious effects that outweigh the benefits of nicotine, and patients with ulcerative colitis are still encouraged to quit smoking. Educational Objective: Active cigarette smoking appears to have a protective role against ulcerative colitis. References: Bastida G, Beltran B. Ulcerative colitis in smokers, non-smokers, and ex-smokers. World J Gastroenterol. 2011;17(22):2740-7. Calkins BM. A meta-analysis of the role of smoking in inflammatory bowel disease. Dig Dis Sci. 1989;34(12):1841-1854. First Aid 2014 page]]
Approved	Approved::Yes
Keyword	WBRKeyword::Cigarette, WBRKeyword::Smoking, WBRKeyword::Nicotine, WBRKeyword::Ulcerative Colitis, WBRKeyword::Protective, WBRKeyword::Inflammatory Bowel Disease, WBRKeyword::Risk Factor, WBRKeyword::Prevention, WBRKeyword::IBD, WBRKeyword::GI Tract, WBRKeyword::Colon, WBRKeyword::Excretory System
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