Inflammatory bowel disease and addiction: more than just smoke?

Abstract

Background Inflammatory bowel disease (IBD) is associated with comorbidities, including psychiatric disorders. However, evidence on concomitant addictions among IBD patients is lacking.

Methods This prospective multicenter cross-sectional analysis investigated the prevalence of the most common addictions (alcohol, nicotine, drugs, food and gambling) in patients with IBD in Germany, with a focus on differences between Crohn’s disease (CD) and ulcerative colitis (UC). Adult patients completed questionnaires covering addictive behavior, IBD-related and general information. Data were analyzed using standard statistical tests and correlation analyses (significance level P<0.05).

Results The study was conducted from April to October 2018, and 202 patients were included in the analysis (67.3% CD; 32.7% UC). Overall addictive behavior and nicotine addiction were more frequent in CD than in UC patients (overall: 41.2% vs. 24.3%; nicotine: 23.5% vs. 9.1%). Alcohol addiction was found in 4.9% of patients, with similar rates in CD and UC. Nicotine addiction was more frequent among females, alcohol addiction among males. Drug, food and gambling addictions were less common (5.0%, 2.0% and 0.5%) and presented only in CD patients. Significant associations were found between addictive behaviors and small intestine involvement, between nicotine addiction and educational qualification, as well as between alcohol addiction and cardiovascular risk factors, comorbidities and body mass index.

Conclusions Over a third of IBD patients exhibit addictive behaviors, with smoking being most prevalent, especially among CD patients. These findings support the recent literature, and highlight the need for interventions to address addiction risks and improve outcomes in CD and UC.

Keywords Inflammatory bowel disease, addictive behavior, Crohn’s disease, ulcerative colitis, comorbidities

Ann Gastroenterol 2026; 39 (5): 619-628