Effect of Breastfeeding on Severity and Clinical Course of Inflammatory Bowel Disease

Abstract

Introduction: Though results are inconclusive, prior studies suggest that breastfeeding (BF) may have a protective role in the development of inflammatory bowel disease (IBD): ulcerative colitis (UC) and Crohn's disease (CD). Our study aimed to analyze the effect of BF on IBD clinical course and severity. Methods: This was a single-center, retrospective study of IBD patients. Patients' mothers completed a 10-question survey with details regarding patients' BF and early child life history. IBD clinical course and severity were obtained via chart review, and collected data included disease-related surgery and hospitalizations, steroid dependence, medication history and presence of peri-anal disease. We defined severe disease by the presence of at least one of the following: IBD-related hospitalization or surgery, steroid dependence or use of tumor necrosis factor inhibitor. We defined moderate disease by the absence of the above factors but use of 6-mercaptopurine or methotrexate. Mild disease was defined by the use of only antibiotics or aminosalicylates. Univariate analysis and multivariate logistic regression models were used to determine the association between BF history and IBD phenotype and severity. Results: Seventy-four patients (18 UC, 56 CD) were studied with mean age 31.1 years (range 16-56). 70% were exclusively breastfed. On univariate analysis, history of BF was protective against IBD-related surgery (23.1% BF vs 45.5% not BF; p=0.05) and hospitalizations (29.4% BF vs 50.0% not BF; p=0.09). History of BF had no association with our pre-defined categories of disease severity (p=0.94). However, BF was associated with an increased risk of peri-anal disease (28.9% BF vs 4.6% not BF; p=0.02). Duration of BF was also associated with the incidence of peri-anal disease (13.2% BF < 3 months vs 31.4% BF > 3 months; p=0.05). On multivariate analysis (adjusted for mode of delivery, history of BF, antibiotic use in the first 6 months of life, disease duration, and maternal/family IBD history), BF remained independently associated with an increased risk of peri-anal disease (OR 16.79, 95% CI 1.70-165.04; p=0.015). Conclusion: A history of breastfeeding is associated with decreased incidence of IBD-related surgery and hospitalization. However, BF is a significant predictor for development of peri-anal disease. Future studies should evaluate this association in larger patient populations and seek to confirm and potentially explain breastfeeding's influence on IBD phenotype.