Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Gastroenterology Reports
Published in: Current Gastroenterology Reports 6/2010

01-12-2010

Epidemiologic Clues to Inflammatory Bowel Disease

Author: Charles N. Bernstein

Published in: Current Gastroenterology Reports | Issue 6/2010

Login to get access

Abstract

In this article, the recent literature exploring the epidemiology of inflammatory bowel disease (IBD) is reviewed. Epidemiologic studies present data on disease burden, but may also provide clues to disease etiology. The emergence of IBD in developing nations warrants a systematic search for environmental changes in those countries to explain the evolution of IBD. The hygiene hypothesis suggests that an alteration in the microbial environment experienced by the host facilitates the evolution of chronic immune-mediated diseases. One complex database study suggested that areas with high species richness of human intestinal helminthes are areas with genetic changes in interleukin gene loci. In other words, over the years, the microbial ecology has affected human genetics, which in turn would have an impact on immune responses. Other factors affect the gut microbiome, and several studies have explored the increase in incidence of IBD in relation to such factors as exogenous infections, use of antibiotics, and diet.
Literature
1.
• Bernstein CN, Fried M, Krabshuis JH, et al.: World Gastroenterology Organization Practice Guidelines for the diagnosis and management of IBD in 2010. Inflamm Bowel Dis 2010, 16:112–124. This article was coauthored by gastroenterologists from around the world and presents an approach to diagnosing and treating IBD from the perspective of different socioeconomic jurisdictions. The authors refer to this as a “cascades” approach, in which different tiers of approaches are based on different resources. PubMed
2.
Baumgart DC, Bernstein CN, Abbas Z, et al.: IBD around the world: comparing the epidemiology, diagnosis and treatment: proceedings of the World Digestive Health Day 2010—inflammatory bowel disease task force meeting. Inflamm Bowel Dis 2010 (Epub ahead of print).
3.
Pinsk V, Lemberg DA, Grewal K, et al.: Inflammatory bowel disease in the South Asian pediatric population of British Columbia. Am J Gastroenterol. 2007, 102:1077–1083.CrossRefPubMed
4.
Probert CS, Jayanthi V, Pinder D, et al.: Epidemiological study of ulcerative proctocolitis in Indian migrants and the indigenous population of Leicestershire. Gut 1992, 33:687–693.CrossRefPubMed
5.
Detels R, Brody JA, Edgar AH: Multiple sclerosis among American, Japanese, and Chinese migrants to California and Washington. J Chronic Dis 1972, 25:3–10.CrossRefPubMed
6.
Staines A, Hamif S, Ahmed S, et al.: Incidence of insulin dependent diabetes mellitus in Karachi, Pakistan. Arch Dis Child 1997, 76:121–123.CrossRefPubMed
7.
Wang YF, Ouyang Q, Hu RW: Progression of inflammatory bowel disease in China. J Dig Dis 2010, 11:76–82.CrossRefPubMed
8.
Asakura K, Nishiwaki Y, Inoue N, et al.: Prevalence of ulcerative colitis and Crohn’s disease in Japan. J Gastroenterol 2009, 44:659–665.CrossRefPubMed
9.
• Benchimol EI, Fortinsky KJ, Gozdyra P, et al.: Epidemiology of pediatric inflammatory bowel disease: a systematic review of international trends. Inflamm Bowel Dis 2010 (Epub ahead of print). This paper review provides a resource of all reports of IBD epidemiology, and shows the trend in the rise of Crohn’s disease relative to UC among children in most nations, particularly in the developed world.
10.
• Bernstein CN, Shanahan F: Disorders of a modern lifestyle; reconciling the epidemiology of inflammatory bowel disease. Gut 2008, 57:1185–1191. This report summarizes trends in the epidemiology of IBD and what clues these trends present toward discerning disease etiology. CrossRefPubMed
11.
Salkic NN, Pavlocik-Salic N, Gegic A, et al.: Ulcerative colitis in the Tuzla region of Bosnia and Herzegovina between 1995 and 2006: epidemiological and clinical characteristics. Eur J Gastroenterol Hepatol 2010, 22:346–353.CrossRefPubMed
12.
• Okada H, Kuhn C, Freillet H, Bach JF: The hygiene hypothesis for autoimmune and allergic diseases: an update. Clin Exp Immunol 2010, 160:1–9. This report updates concepts regarding the hygiene hypothesis as a central underpinning toward the increase in chronic immune diseases. CrossRefPubMed
13.
Masoli M, Fabian D, Holt S, Beasley R: The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy 2004, 59:469–478.CrossRefPubMed
14.
• Sartor RB: Microbial influences in inflammatory bowel diseases. Gastroenterology 2008,134:577–594. This article reviews the evidence for gut dysbiosis in IBD. CrossRefPubMed
15.
•• Fumagalli M, Pozzoli U, Cagliani R, et al.: Parasites represent a major selective force for interleukin genes and shape the genetic predisposition to autoimmune conditions. J Exp Med 2010, 206:1395–1408. This article describes a complex study using two large, publically available databases: one that records the micro- and macropathogen environments affecting humans in several countries; and a second that records the patterns of single nucleotide polymorphisms in humans worldwide. Associating these two databases, the investigators determined that the presence of high richness of helminthes, in particular, exerted pressure on the evolution of genetic changes in several interleukin loci. The conclusion was that microbial environments led to genetic changes that ultimately could produce aberrant inflammatory cytokines leading to chronic immune diseases (eg, IBD). CrossRef
16.
•• Shaw S, Blanchard JF, Bernstein CN: Association between the use of antibiotics in the first year of life and pediatric inflammatory bowel disease. Am J Gastroenterol 2010, in press. In this study, a population-based database of patients with IBD and matched controls was used to show that children diagnosed with IBD before age 8 were more likely than matched controls to have used antibiotics within the first year of life.
17.
Sokol H, Pigneur B, Watterlot L, et al.: Faecalibacterium prausnitzii is an anti-inflammatory commensal bacterium identified by gut microbiota analysis of Crohn disease patients. Proc Natl Acad Sci U S A 2008, 105:16731–16736.CrossRefPubMed
18.
Sepehri S, Kotlowski R, Bernstein CN, Krause DO: Phylogenetic analysis of inflammatory bowel disease associated Escherichia coli and the fimH virulence determinant. Inflamm Bowel Dis 2009, 15:1737–1745.CrossRefPubMed
19.
Martinez-Medina M, Mora A, Blanco M, et al.: Similarity and divergence among adherent-invasive Escherichia coli and extraintestinal pathogenic E. coli strains. J Clin Microbiol 2009, 47:3968–3979.CrossRefPubMed
20.
Barnich N, Carvalho FA, Glasser AL, et al.: CEACAM6 acts as a receptor for adherent-invasive E. coli, supporting ileal mucosa colonization in Crohn disease. J Clin Invest 2007, 117:1566–1574.CrossRefPubMed
21.
Lapaquette P, Glasser AL, Huett A, et al.: Crohn’s disease-associated adherent-invasive E. coli are selectively favoured by impaired autophagy to replicate intracellularly. Cell Microbiol 2010, 12:99–113.CrossRefPubMed
22.
•• Sokol H, Seksik P, Furet JP, et al.: Low counts of Faecalibacterium prausnitzii in colitis microbiota. Inflamm Bowel Dis 2009, 15:1183–1189. This study found that the fecal microbiota of patients with IBD differed from that of healthy subjects with underrepresentation of Firmicutes, and particularly the species Faecalibacterium prausnitzii, in active IBD. However, this same finding was evident in patients with infectious colitis, suggesting that a reduction in these organisms may be secondary to reduced protection of the gut mucosa from different causes. CrossRefPubMed
23.
•• Gradel KO, Nielsen HL, Schonheyder HC, et al.: Increased short- and long-term risk of inflammatory bowel disease after Salmonella or Campylobacter gastroenteritis. Gastroenterology 2009, 137:495–501. In two Danish counties, persons exposed to Salmonella and Campylobacter gastroenteritis identified in laboratory registries were compared with matched unexposed individuals (average follow-up of 7.5 years). The hazard ratio of first-time diagnosis of IBD among exposed to unexposed persons was 1.9 (95% CI, 1.4–2.6), if the first year after exposure was excluded. The hazard ratios were similarly increased for Crohn’s disease and UC. Because these were hospitalized patients with infectious gastroenteritis who ultimately presented with IBD, it is unknown if the risk of milder or subclinical infectious gastroenteritis at inducing IBD might be different. Further, those hospitalized with infectious gastroenteritis may be more likely to undergo diagnostic testing in the future (surveillance bias), and hence be more likely to be diagnosed with IBD. CrossRefPubMed
24.
Garcia Rodriguez LA, Ruigomez A, Panes J: Acute gastroenteritis is followed by an increased risk of inflammatory bowel disease. Gastroenterology 2006, 130:1588–1594.CrossRefPubMed
25.
•• Frisch M, Pedersen BV, Andersson RE: Appendicitis, mesenteric lymphadenitis, and subsequent risk of ulcerative colitis: cohort studies in Sweden and Denmark. BMJ 2009, 338:716–725. This study unequivocally documents that appendicitis is associated with a reduction in incidence of UC, but that merely having an appendectomy (if the appendix is uninflamed) does not. Therefore, it is not that a proinflammatory effect of a normal appendix leads to UC, but rather that the presence and removal of an inflamed appendix is protective. CrossRef
26.
•• Bernstein CN, Singh S, Graff LA, et al.: A prospective population-based study of triggers of symptomatic flares in IBD. Am J Gastroenterol 2010, 105:1994–2002. This article describes a population-based study in which subjects with IBD mailed in questionnaires every 3 months for 1 year, describing their symptoms, use of nonsteroidal inflammatory drugs or antibiotics, and experience of nonintestinal infections or stress. The study investigators found that only the perception of stress in the period prior to flaring of their IBD symptoms was associated with symptom flare. The other variables, which have often been touted as triggers, had no association with a flare. CrossRefPubMed
27.
Eltholth MM, Marsh VR, Van Winden S, Guitian FJ: Contamination of food products with Mycobacterium avium paratuberculosis: a systematic review. J Appl Microbiol 2009, 107:1067–1077.CrossRef
28.
Brady C, O’Grady D, O’Meara F, et al.: Relationships between clinical signs, pathological changes and tissue distribution of Mycobacterium avium subspecies paratuberculosis in 21 cows from herds affected by Johne’s disease. Vet Rec 2008, 162:147–152.CrossRefPubMed
29.
Shankar H, Singh SV, Singh PK, et al.: Presence, characterization, and genotype profiles of Mycobacterium avium subspecies paratuberculosis from unpasteurized individual and pooled milk, commercial pasteurized milk, and milk products in India by culture, PCR, and PCR-REA methods. Int J Infect Dis 2010, 14:e121–e126.CrossRefPubMed
30.
Flint HJ, Duncan SH, Scott KP, Louis P: Interactions and competition within the microbial community of the human colon: links between diet and health. Environ Microbiol 2007, 9:1101–1111.CrossRefPubMed
31.
Wen L, Ley RE, Volchkov PY, et al.: Innate immunity and intestinal microbiota in the development of type I diabetes. Nature 2008, 455:1109–1113.CrossRefPubMed
32.
Hildebrandt MA, Hoffmann C, Sherrill-Mix SA, et al.: High-fat diet determines the composition of the murine gut microbiome independently of obesity. Gastroenterology 2009, 137:1716–1724.CrossRefPubMed
33.
• The IBD in EPIC Study Investigators; Tjonneland A, Overvad K, Bergmann MM, et al.: Linoleic acid, a dietary n-6 polyunsaturated fatty acid, and the aetiology of ulcerative colitis: a nested case-control study within a European prospective cohort study. Gut 2009, 58:1606–1611. This cohort study suggests that healthy adult women ingesting more linoleic acid were more likely over time to present with UC. CrossRefPubMed
34.
• Jantchou P, Morois S, Clavel-Chapelon F, et al.: Animal protein intake and risk of inflammatory bowel disease: the E3N prospective study. Am J Gastroenterol 2010 (Epub ahead of print). This cohort study of healthy adult women suggests that ingesting a diet higher in total protein, particularly animal protein, is associated with a greater likelihood of being diagnosed with IBD, particularly UC.
35.
Shoda R, Matsueda K, Yamato S, et al.: Epidemiological analysis of Crohn’s disease in Japan: increased dietary intake of n-6 polyunsaturated fatty acids and animal proteins relates to the increased incidence in Japan. Am J Clin Nutr 1996, 63:741–745.PubMed
36.
Barclay AR, Russell RK, Wilson ML, et al.: Systematic review: the role of breastfeeding in the development of pediatric inflammatory bowel disease. J Pediatr 2009, 155:421–426.CrossRefPubMed
37.
Huttly SR, Barros FC, Victora GG, et al.: Do mothers overestimate breastfeeding duration? An example of recall bias from a study in southern Brazil. Am J Epidemiol 1990, 132:572–575.PubMed
38.
Rook GA: The 99th Dahlem Conference on infection, inflammation and chronic inflammatory disorders: darwinian medicine and the ‘hygiene’ or ‘old friends’ hypothesis. Clin Exp Immunol 2010, 160:70–79.CrossRefPubMed
39.
Orrhage K, Nord CE: Factors controlling the bacterial colonization of the intestine in breastfed infants. Acta Paediatr Suppl 1999, 88:47–57.CrossRefPubMed
Metadata
Title
Epidemiologic Clues to Inflammatory Bowel Disease
Author
Charles N. Bernstein
Publication date
01-12-2010
Publisher
Current Science Inc.
Published in
Current Gastroenterology Reports / Issue 6/2010
Print ISSN: 1522-8037
Electronic ISSN: 1534-312X
DOI
https://doi.org/10.1007/s11894-010-0144-x

Other articles of this Issue 6/2010

Current Gastroenterology Reports 6/2010 Go to the issue

ReviewPaper

Mechanisms of Intragastric pH Sensing

ReviewPaper

Intraepithelial Lymphocytes: To Serve and Protect

ReviewPaper

The Status of Diagnostic Markers for Inflammatory Bowel Disease

Clinical Trial Report

Clinical Trial Report: Eradication of Helicobacter pylori Reduces the Risk for Subsequent Gastric Cancer

ReviewPaper

Update on the Mechanisms of Gastric Acid Secretion

ReviewPaper

Novel Approaches to Inhibition of Gastric Acid Secretion
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits