Smoking out nicotine's impact on colitis.

Prior to the 1950s, manufacturers promoted cigarette smoking as a healthful habit that encourages relaxation and aids weight control. A new study hints that, in some cases, nicotine may have medicinal value for people afflicted with a debilitating digestive disorder.

That preliminary finding is "certainly not a reason to smoke," comments gastroenterologist Stephen B. Hanauer of the University of Chicago Medical Center. Extensive evidence links cigarette smoking with an array of health hazards, including cancer, he cautions.

The latest twist on the nicotine story began more than a decade ago, when gastroenterologist John Rhodes noticed something curious about people with ulcerative colitis, an inflammation of the lining of the colon that causes bloody diarrhea, severe cramping, and weight loss. Most of these patients did not smoke, he reported in 1982. In addition, smokers who suffered from ulcerative colitis often reported controlling their symptoms with cigarettes. Could nicotine protect against this condition?

To answer that question, Rhodes, of the University Hospital of Wales in Cardiff, and his colleagues recruited 72 ulcerative colitis patients. All 72 of the patients had a worsening condition, despite treatment with conventional anti-inflammatory drugs.

The researchers randomly assigned about half the patients to a group that received nicotine skin patches, which are used by smokers to help them quit smoking (SN: 12/14/91, p.390). The remaining patients got a patch containing an inactive substance. All participants continued taking their usual anticolitis drugs throughout the study. Neither patients nor researchers knew whether a patch contained nicotine or the dummy substance.

After 6 weeks, the scientists discovered that 17 of the 35 patients in the nicotine group reported complete symptomatic relief of their colitis. By contrast, just 9 of 37 people in the placebo group got such a reprieve. The researchers describe their study in the March 24 NEW ENGLAND JOURNAL OF MEDICINE.

The nicotine patches produced side effects, such as nausea, dizziness, headache, sweating, and tremor, in some people. However, the recruits did not seem to suffer withdrawal symptoms when their steady source of nicotine was removed, Rhodes says. It may be that addiction occurs only with the sharp increase in nicotine concentrations in the blood that occurs when a person repeatedly drags on a cigarette, the researchers speculate.

This is the first double-blind, placebo-controlled trial to suggest that nicotine may ease the symptoms of colitis, notes William J. Tremaine of the Mayo Clinic in Rochester, Minn. Drugs commonly used to treat colitis, such as steroids and nonsteroidal anti-inflammatory medications, don't always work and can cause severe side effects, he adds.

Tremaine and his coworkers are conducting a similar study, one that may confirm nicotine's beneficial effects for people with colitis. Yet even if additional research confirms its efficacy. nicotine's role in treating ulcerative colitis may be limited. "It is not a cure for the disease," Hanauer says, noting that the safety of administering this substance remains to be demonstrated. Tobacco companies have recently come under attack for manipulating concentrations of nicotine, a substance widely considered addictive, in their products (SN: 3/19/94, p.190). Hanauer wrote an editorial that appears in the same issue of the journal.

If scientists find a mechanism by which nicotine prevents colitis, they might be able to figure out what causes this disorder. And such understanding could lead to better therapy for this enigmatic disease, Hanauer adds. Nicotine may quiet colitis symptoms by stimulating the production of protective mucus lining the colon, he adds.