SAN DIEGO—Many patients with inflammatory bowel disease have long attested that alcohol has harmful effects on their condition, and data from a meta-analysis presented at DDW 2025 support this notion, at least for those with ulcerative colitis.
Researchers at several institutions across the United States conducted a search of EMBASE, Medline and Web of Science for prospective, longitudinal studies investigating alcohol’s effect on IBD flares, ultimately identifying six studies with a total of 673 participants (poster Mo1974).
Although a pooled analysis did not show a correlation between alcohol and IBD or Crohn’s disease flares, a stratified analysis suggested a significant correlation between alcohol consumption and UC flares (n=330; risk ratio, 2.62; 95% CI, 1.2-5.71).
“While more large-scale studies are needed for definitive conclusions, we hope that the findings of our review provide insight into alcohol’s impact for clinicians and agency for patients in controlling their disease,” study investigator Arpita Jajoo, MD, a third-year resident at Johns Hopkins Bayview Medical Center, in Baltimore, told Gastroenterology & Endoscopy News. “There isn’t yet enough data to quantify a ‘safe’ amount of alcohol consumption, but current research supports at least reducing, if not avoiding, alcohol intake to prevent ulcerative colitis exacerbations.”
The reason for alcohol's differing effects on IBD subtypes is not fully understood, Dr. Jajoo said. Alcohol’s effect on the gastrointestinal system is multifactorial, and “the surface-level injury that alcohol causes to the GI tract lining more directly contributes to the superficial inflammation of UC compared to the transmural inflammation of CD.” Alcohol changes the gut microbiome and weakens the intestinal barrier, she said, triggering an immune activation of the T-helper 2 and 9 phenotypes more closely associated with UC. "There may also be differences in the way that patients with UC metabolize alcohol and in alcohol’s neutralizing effects on topical UC medications," she added.
Further analysis showed that alcohol use was associated with worsening symptoms, endoscopic activity, steroid use, hospitalizations and mortality in limited studies. The investigators found that there may be differential effects of alcohol intake on disease activity, with moderate drinking possibly having a protective effect but heavy drinking associated with disease exacerbation. Commenting on this finding, Dr. Jajoo cautioned that association does not imply a causal link.
“Patients with less severe disease may be able to tolerate alcohol more easily than those with more extensive disease,” Dr. Jajoo said. “Additionally, the harmful effects of ethanol may only be seen at higher doses, while lower doses may not have a significant effect. Any protective effects may also be due to the non-ethanol components of alcoholic drinks, like resveratrol and other polyphenols in red wine.”
More research is needed to better understand the relationship between alcohol consumption and IBD, particularly the type and quantity of alcohol consumed, she noted.
“Practically, patients will be interested in understanding how much alcohol they can drink without feeling worse or risking worsening their disease activity. While conducting longitudinal controlled trials on dietary components is challenging, it could help improve quality of life for patients with IBD and should be prioritized in future work,” Dr. Jajoo said.
“While provocative, there are few studies on this topic,” said Dana Lukin, MD, PhD, the clinical director of translational research and an associate professor of clinical medicine at Weill Cornell Medicine’s Jill Roberts Center for IBD, in New York City, who was not involved in the research. Some of the data come from single studies and should be interpreted with caution, he told Gastroenterology & Endoscopy News, adding that the findings “warrant additional investigation.”
He added: “Overall, these data do suggest that patients with IBD may tolerate alcohol. But the importance of mild to moderate intake should be emphasized due to potential risk for disease exacerbation in patients with UC.”
—Katie Prince
Dr. Jajoo reported no relevant financial disclosures. Dr. Lukin reported financial relationships with AbbVie, Altrubio, Boehringer Ingelheim, Johnson & Johnson, Palatin, Pfizer, Prime Therapeutics, PSI, Takeda and Vedanta. Dr. Lukin is a member of the Gastroenterology & Endoscopy News editorial board.
This article is from the July 2025 print issue.