Abstract
BackgroundEarly life exposures may modify risk of inflammatory bowel diseases (IBD; Crohn’s disease (CD), ulcerative colitis (UC)). However, the relationship between early life exposures and natural history of IBD has not been previously examined.MethodsThis single center study included patients with CD or UC recruited in a prospective IBD registry. Enrolled patients completed a detailed environmental questionnaire that assessed various early life environmental exposures. Our primary outcome was requirement for disease-related surgery in CD and UC. Logistic regression models defined independent effect of early life exposures, adjusting for potential confounders.ResultsOur study included 333 CD and 270 UC patients. Just over half were female with a median age at diagnosis of 25 years. One-third of the cohort had history of bowel surgery (31%) and nearly half had used at least one biologic agent (47%). Among those with CD, being breastfed was associated with reduced risk of CD-related surgery (34% vs. 55%), while childhood cigarette smoke exposure was associated with increased risk. On multivariate analysis, history of being breastfed (odds ratio (OR) 0.21, 95% confidence interval [CI] 0.09–0.46) and cigarette smoke exposure as a child (OR 2.17, 95% CI 1.10–4.29) remained independently associated with surgery. None of the early life variables influenced disease phenotype or outcome in UC.ConclusionA history of being breastfed was associated with a decreased risk while childhood cigarette smoke exposure was associated with an increased risk of surgery in patients with CD. Further investigation to examine biological mechanisms is warranted.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-014-0216-8) contains supplementary material, which is available to authorized users.
Highlights
Life exposures may modify risk of inflammatory bowel diseases (IBD; Crohn’s disease (CD), ulcerative colitis (UC))
Inflammatory bowel disease (IBD), which comprises Crohn’s disease (CD) and ulcerative colitis (UC), are chronic immune mediated diseases characterized by a dysregulated immune response to commensal flora in a genetically susceptible host [1]
Growing literature demonstrating microbial dysbiosis in patients with IBD with reduced diversity [1,6,7,8], decreased representation of potentially protective bacteria like Faecalibacterium prausnitzii [9] and increased frequency of potentially pathogenic bacteria in certain disease subsets like ileal CD [10] suggests that one possible mechanism through which the environment influences disease risk may be through the microbiome
Summary
Life exposures may modify risk of inflammatory bowel diseases (IBD; Crohn’s disease (CD), ulcerative colitis (UC)). The relatively recent secular increase in disease incidence [3] and the changes in disease risk occurring with migration [4,5] suggest an important role for the modifiable external environment in pathogenesis. Growing literature demonstrating microbial dysbiosis in patients with IBD with reduced diversity [1,6,7,8], decreased representation of potentially protective bacteria like Faecalibacterium prausnitzii [9] and increased frequency of potentially pathogenic bacteria in certain disease subsets like ileal CD [10] suggests that one possible mechanism through which the environment influences disease risk may be through the microbiome. The spectrum of risk factors examined range from gestational age and mode of delivery to breastfeeding, antibiotic use, exposure to
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