Environmental risk factors in paediatric inflammatory bowel diseases: a population based case control study

• Published in: Gut Vol. 54; no. 3; pp. 357 - 363
• Main Authors: Baron, S, Turck, D, Leplat, C, Merle, V, Gower-Rousseau, C, Marti, R, Yzet, T, Lerebours, E, Dupas, J-L, Debeugny, S, Salomez, J-L, Cortot, A, Colombel, J-F
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.03.2005; BMJ; BMJ Publishing Group LTD; Copyright 2005 by Gut
• Subjects: Adolescent; Age; Age of Onset; Allergic diseases; bacille Calmette-Guerin; Bacterial diseases; BCG; BCG Vaccine - adverse effects; Biological and medical sciences; Breast Feeding - adverse effects; Case-Control Studies; Child; children; Colitis, Ulcerative - etiology; Colitis, Ulcerative - genetics; Crohn Disease - etiology; Crohn Disease - genetics; Crohn’s disease; Diet; Eczema - complications; Environment; Epidemiology; Female; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Health risk assessment; Human bacterial diseases; Humans; IBD; Immunopathology; Infections; Infectious diseases; Inflammatory Bowel Disease; Inflammatory Bowel Diseases - etiology; Inflammatory Bowel Diseases - genetics; Male; Measles; measles-mumps-rubella; Medical sciences; MMR; Mumps; Odds Ratio; Other diseases. Semiology; Population; Pregnancy; Pregnancy Complications; Risk Factors; Skin allergic diseases. Stinging insect allergies; Socioeconomic factors; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Studies; Tuberculosis and atypical mycobacterial infections; ulcerative colitis; Vaccination - adverse effects; Vaccines; France; Allergy; Skin disease; Questionnaire; Vaccination; Sex; Check; Environmental factor; Infant; Mycobacterial infection; Case control study; Epidemiology; Case history; Inflammatory disease; Vermiform appendix; Etiology; Surgery; Eczema; Intestinal disease; Child; Age; Human; Immunopathology; Family study; Perinatal; Method; Infection; Crohn disease; Immunoprophylaxis; Diet therapy; Tuberculosis; Diet; Risk factor; Bacteriosis; Digestive diseases; Early; Ulcerative colitis
• ISSN: 0017-5749; 1468-3288; 1458-3288
• DOI: 10.1136/gut.2004.054353

Background: Environmental exposures in early life have been implicated in the aetiology of inflammatory bowel disease. Objective: To examine environmental risk factors prior to the development of inflammatory bowel disease in a paediatric population based case control study. Methods: A total of 222 incident cases of Crohn’s disease and 60 incident cases of ulcerative colitis occurring before 17 years of age between January 1988 and December 1997 were matched with one control subject by sex, age, and geographical location. We recorded 140 study variables in a questionnaire that covered familial history of inflammatory bowel disease, events during the perinatal period, infant and child diet, vaccinations and childhood diseases, household amenities, and the family’s socioeconomic status. Results: In a multivariate model, familial history of inflammatory bowel disease (odds ratio (OR) 4.3 (95% confidence interval 2.3–8)), breast feeding (OR 2.1 (1.3–3.4)), bacille Calmette-Guerin vaccination (OR 3.6 (1.1–11.9)), and history of eczema (OR 2.1 (1–4.5)) were significant risk factors for Crohn’s disease whereas regular drinking of tap water was a protective factor (OR 0.56 (0.3–1)). Familial history of inflammatory bowel disease (OR 12.5 (2.2–71.4)), disease during pregnancy (OR 8.9 (1.5–52)), and bedroom sharing (OR 7.1 (1.9–27.4)) were risk factors for ulcerative colitis whereas appendicectomy was a protective factor (OR 0.06 (0.01–0.36)). Conclusions: While family history and appendicectomy are known risk factors, changes in risk based on domestic promiscuity, certain vaccinations, and dietary factors may provide new aetiological clues.