Electronic Nicotine Delivery Systems and Clinical Outcomes in Adults With Inflammatory Bowel Disease: A Systematic Review of Emerging Evidence

Authors

• Hatem Ahmed
• Motaz Almahmood
• Alexandra Short
• Sameh Gomaa
• Khloud S. Abdelrazeq
• Aamir Shahzad
• Ali Alharethi
• Khaled Elsokary
• Mohamed K. Mansour, Rochester Regional HealthFollow
• John Marshall

Department

Internal Medicine

Document Type

Article

Publication Title

Cureus

Abstract

Electronic nicotine delivery systems (ENDSs), including e-cigarettes and vaping, are increasingly used by adults with inflammatory bowel disease, often during smoking cessation or transition from combustible cigarettes, yet their clinical implications remain uncertain. We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. MEDLINE, Embase, Web of Science, and Scopus were searched from inception through December 18, 2025, together with grey literature sources; the search was rerun on April 24, 2026, identifying no additional eligible studies. Two reviewers independently screened studies and extracted data, and risk of bias was assessed using design-appropriate tools. Four observational studies involving 1,869 participants, of whom 178 were ENDS users, met inclusion criteria. In nonoperative settings, a matched case-control study found no association between current e-cigarette use and a composite outcome of biologic initiation or change, hospitalization, or surgery; smaller cohorts were imprecise. In postoperative Crohn's disease, endoscopic recurrence at one year was higher among exclusive e-cigarette users than among nonsmokers, with a directionally elevated but statistically nonsignificant adjusted estimate and higher biochemical activity also observed. Available evidence does not demonstrate a consistent association between current ENDS use and major inflammatory bowel disease outcomes in nonoperative settings, but a possible signal exists for higher postoperative endoscopic recurrence among e-cigarette users. Larger prospective studies with standardized exposure definitions are needed.

First Page

e108605

DOI

10.7759/cureus.108605

Volume

18

Issue

5

Publication Date

5-1-2026

PubMed ID

42281709

Recommended Citation

Ahmed, H., Almahmood, M., Short, A., Gomaa, S., Abdelrazeq, K. S., Shahzad, A., Alharethi, A., Elsokary, K., Mansour, M. K., & Marshall, J. (2026). Electronic Nicotine Delivery Systems and Clinical Outcomes in Adults With Inflammatory Bowel Disease: A Systematic Review of Emerging Evidence. Cureus, 18 (5), e108605. https://doi.org/10.7759/cureus.108605