Abstract

BackgroundEnvironmental factors during childhood are thought to play a role in the aetiolgy of Crohn's Disease (CD). However the association between age at time of exposure and the subsequent development of CD in South Africa is unknown.MethodsA case control study of all consecutive CD patients seen at 2 large inflammatory bowel disease (IBD) referral centers in the Western Cape, South Africa between September 2011 and January 2013 was performed. Numerous environmental exposures during 3 age intervals; 0–5, 6–10 and 11–18 years were extracted using an investigator administered questionnaire. An agreement analysis was performed to determine the reliability of questionnaire data for all the relevant variables.ResultsThis study included 194 CD patients and 213 controls. On multiple logistic regression analysis, a number of childhood environmental exposures during the 3 age interval were significantly associated with the risk of developing CD. During the age interval 6–10 years, never having had consumed unpasteurized milk (OR = 5.84; 95% CI, 2.73–13.53) and never having a donkey, horse, sheep or cow on the property (OR = 2.48; 95% CI, 1.09–5.98) significantly increased the risk of developing future CD. During the age interval 11–18 years, an independent risk-association was identified for; never having consumed unpasteurized milk (OR = 2.60; 95% CI, 1.17–6.10) and second-hand cigarette smoke exposure (OR = 1.93; 95% CI, 1.13–3.35).ConclusionThis study demonstrates that both limited microbial exposures and exposure to second-hand cigarette smoke during childhood is associated with future development of CD.

Highlights

  • The pathogenesis of Crohn’s disease (CD) remains poorly understood, but is thought to reflect a complex interaction between genetic susceptibility, a defective immune system, the gastrointestinal microbiome and environmental factors

  • A case control study of all consecutive CD patients seen at 2 large inflammatory bowel disease (IBD) referral centers in the Western Cape, South Africa between September 2011 and January 2013 was performed

  • This study demonstrates that both limited microbial exposures and exposure to second-hand cigarette smoke during childhood is associated with future development of CD

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Summary

Introduction

The pathogenesis of Crohn’s disease (CD) remains poorly understood, but is thought to reflect a complex interaction between genetic susceptibility, a defective immune system, the gastrointestinal microbiome and environmental factors. North America and Europe have historically reported the highest incidence and prevalence rates of CD in the world During the latter part of the 20th century as incidence rates have begun to stabilize in these nations, a dramatic rise in CD incidence has been observed within developing nations, as they become increasingly industrialized [1, 2]. On multiple logistic regression analysis, a number of childhood environmental exposures during the 3 age interval were significantly associated with the risk of developing CD. During the age interval 11–18 years, an independent riskassociation was identified for; never having consumed unpasteurized milk (OR52.60; 95% CI, 1.17–6.10) and second-hand cigarette smoke exposure (OR51.93; 95% CI, 1.13–3.35)

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