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Published in: Indian Journal of Gastroenterology 3/2018

01-05-2018 | Original Article

Risk factors for inflammatory bowel disease: A prospective multi-center study

Authors: Anjali D. Amarapurkar, Deepak N. Amarapurkar, Pravin Rathi, Prabha Sawant, Nikhil Patel, Praful Kamani, Krishnakant Rawal, Rajiv Baijal, Ameya Sonawane, Nitin Narawane, Samrat Kolekar, Naveen Totla

Published in: Indian Journal of Gastroenterology | Issue 3/2018

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Abstract

Introduction

Environmental risk factors have been associated with inflammatory bowel disease (IBD). With rising incidence, it is important to know risk factors associated with IBD in our population. This study was aimed to evaluate risk factors for IBD from western India.

Methods

This was prospective, multi-center case-control study which included 1054 patients with IBD of which 765 (72.5%) were ulcerative colitis (UC) and 289 (27.4%) Crohn’s disease (CD). Asymptomatic individuals without a history of any major illness served as controls. The questionnaire containing risk factors for IBD was given to patients and control group. Odds ratio and 95% confidence interval were calculated for each variable.

Result

Significant numbers of patients with CD were from rural area. Rural environment (OR 1.071, 0.82–1.38 and OR 1.441, 1.02–2.02), higher education (OR 1.830, 1.52–2.19 and OR 1.519, 1.16–1.97), professional by occupation (OR 1.754, 1.46–2.09 and OR 1.293, 0.99–1.67), annual family income >100,000 Indian national rupees (OR 2.185, 1.52–3.13 and OR 4.648, 3.10–6.95), history of appendectomy (OR 3.158, 1.71–5.80 and OR 3.158, 1.71–5.80), and family history of IBD (OR 4.510, 2.19–9.25 and OR 3.972, 1.58–9.96) were the risk factors for UC and CD, respectively. Vegetarian diet was protective factor for UC (OR 0.29, 0.27–0.39) and risk for CD (OR 1.179, 0.88–1.57). Smoking and chronic alcoholism were not found to be the risk factors.

Conclusion

This study highlights association between socioeconomic, dietary factors, appendectomy, and family history as risk factors for IBD.
Literature
1.
go back to reference M’Koma AE. Inflammatory bowel disease: an expanding global health problem. Clin Med Insights Gastroenterol. 2013;6:33–47.PubMedPubMedCentral M’Koma AE. Inflammatory bowel disease: an expanding global health problem. Clin Med Insights Gastroenterol. 2013;6:33–47.PubMedPubMedCentral
2.
go back to reference Ananthakrishnan AN. Epidemiology and risk factors for inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2015;12:205–17.CrossRefPubMed Ananthakrishnan AN. Epidemiology and risk factors for inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2015;12:205–17.CrossRefPubMed
3.
go back to reference Ponder A, Long MD. A clinical review of recent findings in the epidemiology of inflammatory bowel diseases. Clin Epidemiol. 2013;5:237–47.PubMedPubMedCentral Ponder A, Long MD. A clinical review of recent findings in the epidemiology of inflammatory bowel diseases. Clin Epidemiol. 2013;5:237–47.PubMedPubMedCentral
4.
go back to reference Molodecky NA, Soon IS, Rabi DM, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142:46–54.e42. Molodecky NA, Soon IS, Rabi DM, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142:46–54.e42.
5.
go back to reference Yang Y, Owyang C, Wu GD. East meets West: the increasing incidence of inflammatory bowel disease in Asia as a paradigm for environmental effects on the pathogenesis of immune-mediated disease. Gastroenterology. 2016;151:e1–e5.CrossRefPubMedPubMedCentral Yang Y, Owyang C, Wu GD. East meets West: the increasing incidence of inflammatory bowel disease in Asia as a paradigm for environmental effects on the pathogenesis of immune-mediated disease. Gastroenterology. 2016;151:e1–e5.CrossRefPubMedPubMedCentral
6.
go back to reference Ng SC, Tang W, Ching JY, et al. Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn’s and colitis epidemiology study. Gastroenterology. 2013;145:158–165.e2.CrossRefPubMed Ng SC, Tang W, Ching JY, et al. Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn’s and colitis epidemiology study. Gastroenterology. 2013;145:158–165.e2.CrossRefPubMed
9.
go back to reference Montgomery SM, Morris DL, Pounder RE, Wakefield AJ. Asian ethnic origin and the risk of inflammatory bowel disease. Eur J Gastroenterol Hepatol. 1999;11:543–6.CrossRefPubMed Montgomery SM, Morris DL, Pounder RE, Wakefield AJ. Asian ethnic origin and the risk of inflammatory bowel disease. Eur J Gastroenterol Hepatol. 1999;11:543–6.CrossRefPubMed
10.
go back to reference Bernstein CN, Shanahan F. Disorders of a modern lifestyle: reconciling the epidemiology of inflammatory bowel diseases. Gut. 2008;57:1185–91.CrossRefPubMed Bernstein CN, Shanahan F. Disorders of a modern lifestyle: reconciling the epidemiology of inflammatory bowel diseases. Gut. 2008;57:1185–91.CrossRefPubMed
11.
go back to reference Khosla SN, Girdhar NK, Lal S, Mishra DS. Epidemiology of ulcerative colitis in hospital and select general population of northern India. J Assoc Physicians India. 1986;34:405–7.PubMed Khosla SN, Girdhar NK, Lal S, Mishra DS. Epidemiology of ulcerative colitis in hospital and select general population of northern India. J Assoc Physicians India. 1986;34:405–7.PubMed
12.
13.
go back to reference Das K, Ghoshal UC, Dhali GK, Benjamin J, Ahuja V, Makharia GK. Crohn’s disease in India: a multicenter study from a country where tuberculosis is endemic. Dig Dis Sci. 2009;54:1099–107.CrossRefPubMed Das K, Ghoshal UC, Dhali GK, Benjamin J, Ahuja V, Makharia GK. Crohn’s disease in India: a multicenter study from a country where tuberculosis is endemic. Dig Dis Sci. 2009;54:1099–107.CrossRefPubMed
14.
go back to reference Amarapurkar DN, Patel ND, Rane PS. Diagnosis of Crohn’s disease in India where tuberculosis is widely prevalent. World J Gastroenterol. 2008;14:741–6. Amarapurkar DN, Patel ND, Rane PS. Diagnosis of Crohn’s disease in India where tuberculosis is widely prevalent. World J Gastroenterol. 2008;14:741–6.
15.
go back to reference Cleynen I, Boucher G, Jostins L, et al. Inherited determinants of Crohn’s disease and ulcerative colitis phenotypes: a genetic association study. Lancet. 2016;387:156–67.CrossRefPubMedPubMedCentral Cleynen I, Boucher G, Jostins L, et al. Inherited determinants of Crohn’s disease and ulcerative colitis phenotypes: a genetic association study. Lancet. 2016;387:156–67.CrossRefPubMedPubMedCentral
16.
go back to reference Pugazhendhi S, Sahu MK, Subramanian V, Pulimood A, Ramakrishna BS. Environmental factors associated with Crohn’s disease in India. Indian J Gastroenterol. 2011;30:264–9.CrossRefPubMed Pugazhendhi S, Sahu MK, Subramanian V, Pulimood A, Ramakrishna BS. Environmental factors associated with Crohn’s disease in India. Indian J Gastroenterol. 2011;30:264–9.CrossRefPubMed
17.
go back to reference Sood A, Amre D, Midha V, A, et al. Low hygiene and exposure to infections may be associated with increased risk for ulcerative colitis in a North Indian population. Ann Gastroenterol. 2014;27:219–23. Sood A, Amre D, Midha V, A, et al. Low hygiene and exposure to infections may be associated with increased risk for ulcerative colitis in a North Indian population. Ann Gastroenterol. 2014;27:219–23.
18.
go back to reference Makharia GK, Ramakrishna BS, Abraham P, et al. Survey of inflammatory bowel diseases in India. Indian J Gastroenterol. 2012;31:299–306.CrossRefPubMed Makharia GK, Ramakrishna BS, Abraham P, et al. Survey of inflammatory bowel diseases in India. Indian J Gastroenterol. 2012;31:299–306.CrossRefPubMed
19.
go back to reference Soon IS, Molodecky NA, Rabi DM, Ghali WA, Barkema HW, Kaplan GG. The relationship between urban environment and the inflammatory bowel diseases: a systematic review and meta-analysis. BMC Gastroenterol. 2012;12:51.CrossRefPubMedPubMedCentral Soon IS, Molodecky NA, Rabi DM, Ghali WA, Barkema HW, Kaplan GG. The relationship between urban environment and the inflammatory bowel diseases: a systematic review and meta-analysis. BMC Gastroenterol. 2012;12:51.CrossRefPubMedPubMedCentral
20.
go back to reference Maté-Jimenez J, Muñoz S, Vicent D, Pajares JM. Incidence and prevalence of ulcerative colitis and Crohn’s disease in urban and rural areas of Spain from 1981 to 1988. J Clin Gastroenterol. 1994;18:27–31.CrossRefPubMed Maté-Jimenez J, Muñoz S, Vicent D, Pajares JM. Incidence and prevalence of ulcerative colitis and Crohn’s disease in urban and rural areas of Spain from 1981 to 1988. J Clin Gastroenterol. 1994;18:27–31.CrossRefPubMed
21.
go back to reference Wang YF, Ou-Yang Q, Xia B, et al. Multicenter case-control study of the risk factors for ulcerative colitis in China. World J Gastroenterol. 2013;19:1827–33. Wang YF, Ou-Yang Q, Xia B, et al. Multicenter case-control study of the risk factors for ulcerative colitis in China. World J Gastroenterol. 2013;19:1827–33.
22.
go back to reference Ng SC, Tang W, Leong RW, et al. Environmental risk factors in inflammatory bowel disease: a population-based case-control study in Asia-Pacific. Gut. 2015;64:1063–71. Ng SC, Tang W, Leong RW, et al. Environmental risk factors in inflammatory bowel disease: a population-based case-control study in Asia-Pacific. Gut. 2015;64:1063–71.
24.
go back to reference Hou JK, Lee D, Lewis J. Diet and inflammatory bowel disease: review of patient-targeted recommendations. Clin Gastroenterol Hepatol. 2014;12:1592–600.CrossRefPubMed Hou JK, Lee D, Lewis J. Diet and inflammatory bowel disease: review of patient-targeted recommendations. Clin Gastroenterol Hepatol. 2014;12:1592–600.CrossRefPubMed
25.
go back to reference Ananthakrishnan AN, Khalili H, Song M, et al. High school diet and risk of Crohn’s disease and ulcerative colitis. Inflamm Bowel Dis. 2015;21:2311–9. Ananthakrishnan AN, Khalili H, Song M, et al. High school diet and risk of Crohn’s disease and ulcerative colitis. Inflamm Bowel Dis. 2015;21:2311–9.
26.
27.
go back to reference Kuenzig ME, Lee SM, Eksteen B, et al. Smoking influences the need for surgery in patients with the inflammatory bowel diseases: a systematic review and meta-analysis incorporating disease duration. BMC Gastroenterol. 2016;16:143. Kuenzig ME, Lee SM, Eksteen B, et al. Smoking influences the need for surgery in patients with the inflammatory bowel diseases: a systematic review and meta-analysis incorporating disease duration. BMC Gastroenterol. 2016;16:143.
28.
go back to reference Lunney PC, Kariyawasam VC, Wang RR, et al. Smoking prevalence and its influence on disease course and surgery in Crohn’s disease and ulcerative colitis. Aliment Pharmacol Ther. 2015;42:61–70. Lunney PC, Kariyawasam VC, Wang RR, et al. Smoking prevalence and its influence on disease course and surgery in Crohn’s disease and ulcerative colitis. Aliment Pharmacol Ther. 2015;42:61–70.
29.
go back to reference Calkins BM. A meta-analysis of the role of smoking in inflammatory bowel disease. Dig Dis Sci 1989;34:1841–54. Calkins BM. A meta-analysis of the role of smoking in inflammatory bowel disease. Dig Dis Sci 1989;34:1841–54.
30.
go back to reference Bernstein CN, Wajda A, Svenson LW, et al. The epidemiology of inflammatory bowel disease in Canada: a population-based study. Am J Gastroenterol. 2006;101:1559–68. Bernstein CN, Wajda A, Svenson LW, et al. The epidemiology of inflammatory bowel disease in Canada: a population-based study. Am J Gastroenterol. 2006;101:1559–68.
31.
go back to reference Bergmann MM, Hernandez V, Bernigau W, et al. No association of alcohol use and the risk of ulcerative colitis or Crohn’s disease: data from a European Prospective cohort study (EPIC). Eur J Clin Nutr. 2017;71:512–8. Bergmann MM, Hernandez V, Bernigau W, et al. No association of alcohol use and the risk of ulcerative colitis or Crohn’s disease: data from a European Prospective cohort study (EPIC). Eur J Clin Nutr. 2017;71:512–8.
32.
go back to reference Jiang L, Xia B, Li J, et al. Risk factors for ulcerative colitis in a Chinese population: an age-matched and sex-matched case-control study. J Clin Gastroenterol. 2007;41:280–4. Jiang L, Xia B, Li J, et al. Risk factors for ulcerative colitis in a Chinese population: an age-matched and sex-matched case-control study. J Clin Gastroenterol. 2007;41:280–4.
33.
go back to reference Swanson GR, Sedghi S, Farhadi A, Keshavarzian A. Pattern of alcohol consumption and its effect on gastrointestinal symptoms in inflammatory bowel disease. Alcohol. 2010;44:223–8.CrossRefPubMedPubMedCentral Swanson GR, Sedghi S, Farhadi A, Keshavarzian A. Pattern of alcohol consumption and its effect on gastrointestinal symptoms in inflammatory bowel disease. Alcohol. 2010;44:223–8.CrossRefPubMedPubMedCentral
34.
go back to reference Anderson RE, Olaison G, Tysk C, Ekbom A. Appendectomy and protection against ulcerative colitis. N Engl J Med. 2001;344:808–14.CrossRef Anderson RE, Olaison G, Tysk C, Ekbom A. Appendectomy and protection against ulcerative colitis. N Engl J Med. 2001;344:808–14.CrossRef
35.
go back to reference Kaplan GG, Jackson T, Sands BE, Frisch M, Andersson RE, Korzenik J. The risk of developing Crohn’s disease after an appendectomy: a meta-analysis. Am J Gastroenterol. 2008;103:2925–31.CrossRefPubMed Kaplan GG, Jackson T, Sands BE, Frisch M, Andersson RE, Korzenik J. The risk of developing Crohn’s disease after an appendectomy: a meta-analysis. Am J Gastroenterol. 2008;103:2925–31.CrossRefPubMed
36.
go back to reference Moller FT, Andersen V, Wohlfahrt J, Jess T. Familial risk of inflammatory bowel disease: a population-based cohort study 1977-2011. Am J Gastroenterol. 2015;110:564–71.CrossRefPubMed Moller FT, Andersen V, Wohlfahrt J, Jess T. Familial risk of inflammatory bowel disease: a population-based cohort study 1977-2011. Am J Gastroenterol. 2015;110:564–71.CrossRefPubMed
37.
go back to reference Orholm M, Fonager K, Sørensen HT. Risk of ulcerative colitis and Crohn’s disease among offspring of patients with chronic inflammatory bowel disease. Am J Gastroenterol. 1999;94:3236–8.CrossRefPubMed Orholm M, Fonager K, Sørensen HT. Risk of ulcerative colitis and Crohn’s disease among offspring of patients with chronic inflammatory bowel disease. Am J Gastroenterol. 1999;94:3236–8.CrossRefPubMed
38.
go back to reference Wang PQ, Hu J, Al Kazzi ES, et al. Family history and disease outcomes in patients with Crohn’s disease: a comparison between China and the United States. World J Gastrointest Pharmacol Ther. 2016;7:556–63.CrossRefPubMedPubMedCentral Wang PQ, Hu J, Al Kazzi ES, et al. Family history and disease outcomes in patients with Crohn’s disease: a comparison between China and the United States. World J Gastrointest Pharmacol Ther. 2016;7:556–63.CrossRefPubMedPubMedCentral
39.
go back to reference Kevans D, Silverberg MS, Borowski K, et al. IBD genetic risk profile in healthy first-degree relatives of Crohn’s disease patients. J Crohns Colitis. 2016;10:209–15. Kevans D, Silverberg MS, Borowski K, et al. IBD genetic risk profile in healthy first-degree relatives of Crohn’s disease patients. J Crohns Colitis. 2016;10:209–15.
40.
go back to reference Ardizzone S, Puttini PS, Cassinotti A, Porro GB. Extraintestinal manifestations of inflammatory bowel disease. Dig Liver Dis. 2008 Jul;40 Suppl 2:S253–9.CrossRefPubMed Ardizzone S, Puttini PS, Cassinotti A, Porro GB. Extraintestinal manifestations of inflammatory bowel disease. Dig Liver Dis. 2008 Jul;40 Suppl 2:S253–9.CrossRefPubMed
41.
go back to reference Isene R, Bernklev T, Høie O, et al. Extraintestinal manifestations in Crohn’s disease and ulcerative colitis: results from a prospective, population-based European inception cohort. Scand J Gastroenterol. 2015;50:300–5. Isene R, Bernklev T, Høie O, et al. Extraintestinal manifestations in Crohn’s disease and ulcerative colitis: results from a prospective, population-based European inception cohort. Scand J Gastroenterol. 2015;50:300–5.
Metadata
Title
Risk factors for inflammatory bowel disease: A prospective multi-center study
Authors
Anjali D. Amarapurkar
Deepak N. Amarapurkar
Pravin Rathi
Prabha Sawant
Nikhil Patel
Praful Kamani
Krishnakant Rawal
Rajiv Baijal
Ameya Sonawane
Nitin Narawane
Samrat Kolekar
Naveen Totla
Publication date
01-05-2018
Publisher
Springer India
Published in
Indian Journal of Gastroenterology / Issue 3/2018
Print ISSN: 0254-8860
Electronic ISSN: 0975-0711
DOI
https://doi.org/10.1007/s12664-018-0850-0

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