I am 50 and smoke eight to 10 cigarettes a day. I have Crohn's disease that's been in remission for a number of years, except for when I stop smoking. Hypnosis and the nicotine patch both work great to help me stop smoking. But about a week into the program, my Crohn's pops out of remission with a vengeance, only to go back into remission when I begin smoking again. What can I do to stop smoking without the Crohn's coming back at me?

L.P.

It is interesting that your Crohn's disease tends to flare when you stop smoking. Many doctors have noted that patients with ulcerative colitis (an inflammatory disease that produces symptoms similar to Crohn's) tend to have a worsening of their disease when they stop smoking. It is not known why this phenomenon occurs. Studies have also found that patients with ulcerative colitis who resume smoking (after years of abstinence) often experience a remission of their disease. In contrast, many studies have shown that smoking makes the symptoms of Crohn's disease much worse.

So, based on your the symptoms you describe, it is possible that you have ulcerative colitis and not Crohn's. In some cases it is very difficult to determine with certainty which condition a patient has, since both tend to involve the colon. Ulcerative colitis is limited to the rectum and colon, so involvement of other parts of the intestine generally indicates Crohn's.

Another possible explanation for why your disease worsens when you stop smoking may be related to stress. While anxiety and stress are not the primary causes of Crohn's, it is clear that in some people, the disease can worsen in times of stress. Patients who try to quit smoking often go through a difficult period of adjustment, which may be very stressful. This may explain the timing of your Crohn's flare-ups.

You should follow up with an internist to get more advice on smoking cessation programs and strategies. You should also mention your symptoms to your gastroenterologist, who can review your case to determine if you may actually have ulcerative colitis.