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Hormone therapy increases risk of ulcerative colitis but not Crohn's disease.
Gastroenterology 2012; 143(5):1199-1206G

Abstract

BACKGROUND & AIMS

Estrogen has been proposed to modulate gut inflammation through an effect on estrogen receptors found on gastrointestinal epithelial and immune cells. The role of postmenopausal hormone therapy on risk of Crohn's disease (CD) and ulcerative colitis (UC) is unclear.

METHODS

We conducted a prospective cohort study of 108,844 postmenopausal US women (median age, 54 years) enrolled in 1976 in the Nurses' Health Study without a prior history of CD or UC. Every 2 years, we have updated information on menopause status, postmenopausal hormone use, and other risk factors. Self-reported diagnoses of CD and UC were confirmed through medical record review by 2 gastroenterologists who were blinded to exposure information. We used Cox proportional hazards models to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Through 2008, with more than 1.8 million person-years of follow-up, we documented 138 incident cases of CD and 138 cases of UC. Compared with women who never used hormones, the multivariate-adjusted HR for UC was 1.71 (95% CI, 1.07-2.74) among women who currently used hormones and 1.65 (95% CI, 1.03-2.66) among past users. The risk of UC appeared to increase with longer duration of hormone use (P(trend) = .04) and decreased with time since discontinuation. There was no difference in risk according to the type of hormone therapy used (estrogen vs estrogen plus progestin). In contrast, we did not observe an association between current use of hormones and risk of CD (multivariate-adjusted HR, 1.19; 95% CI, 0.78-1.82). The effect of hormones on risk of UC and CD was not modified by age, body mass index, or smoking.

CONCLUSIONS

In a large prospective cohort of women, postmenopausal hormone therapy was associated with an increased risk of UC but not CD. These findings indicate that pathways related to estrogens might mediate the pathogenesis of UC.

Authors+Show Affiliations

Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.Division of Gastroenterology and Nutrition, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts.Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address: achan@partners.org.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22841783

Citation

Khalili, Hamed, et al. "Hormone Therapy Increases Risk of Ulcerative Colitis but Not Crohn's Disease." Gastroenterology, vol. 143, no. 5, 2012, pp. 1199-1206.
Khalili H, Higuchi LM, Ananthakrishnan AN, et al. Hormone therapy increases risk of ulcerative colitis but not Crohn's disease. Gastroenterology. 2012;143(5):1199-1206.
Khalili, H., Higuchi, L. M., Ananthakrishnan, A. N., Manson, J. E., Feskanich, D., Richter, J. M., ... Chan, A. T. (2012). Hormone therapy increases risk of ulcerative colitis but not Crohn's disease. Gastroenterology, 143(5), pp. 1199-1206. doi:10.1053/j.gastro.2012.07.096.
Khalili H, et al. Hormone Therapy Increases Risk of Ulcerative Colitis but Not Crohn's Disease. Gastroenterology. 2012;143(5):1199-1206. PubMed PMID: 22841783.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hormone therapy increases risk of ulcerative colitis but not Crohn's disease. AU - Khalili,Hamed, AU - Higuchi,Leslie M, AU - Ananthakrishnan,Ashwin N, AU - Manson,JoAnn E, AU - Feskanich,Diane, AU - Richter,James M, AU - Fuchs,Charles S, AU - Chan,Andrew T, Y1 - 2012/07/27/ PY - 2012/02/16/received PY - 2012/07/09/revised PY - 2012/07/17/accepted PY - 2012/7/31/entrez PY - 2012/7/31/pubmed PY - 2013/1/15/medline SP - 1199 EP - 1206 JF - Gastroenterology JO - Gastroenterology VL - 143 IS - 5 N2 - BACKGROUND & AIMS: Estrogen has been proposed to modulate gut inflammation through an effect on estrogen receptors found on gastrointestinal epithelial and immune cells. The role of postmenopausal hormone therapy on risk of Crohn's disease (CD) and ulcerative colitis (UC) is unclear. METHODS: We conducted a prospective cohort study of 108,844 postmenopausal US women (median age, 54 years) enrolled in 1976 in the Nurses' Health Study without a prior history of CD or UC. Every 2 years, we have updated information on menopause status, postmenopausal hormone use, and other risk factors. Self-reported diagnoses of CD and UC were confirmed through medical record review by 2 gastroenterologists who were blinded to exposure information. We used Cox proportional hazards models to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: Through 2008, with more than 1.8 million person-years of follow-up, we documented 138 incident cases of CD and 138 cases of UC. Compared with women who never used hormones, the multivariate-adjusted HR for UC was 1.71 (95% CI, 1.07-2.74) among women who currently used hormones and 1.65 (95% CI, 1.03-2.66) among past users. The risk of UC appeared to increase with longer duration of hormone use (P(trend) = .04) and decreased with time since discontinuation. There was no difference in risk according to the type of hormone therapy used (estrogen vs estrogen plus progestin). In contrast, we did not observe an association between current use of hormones and risk of CD (multivariate-adjusted HR, 1.19; 95% CI, 0.78-1.82). The effect of hormones on risk of UC and CD was not modified by age, body mass index, or smoking. CONCLUSIONS: In a large prospective cohort of women, postmenopausal hormone therapy was associated with an increased risk of UC but not CD. These findings indicate that pathways related to estrogens might mediate the pathogenesis of UC. SN - 1528-0012 UR - https://www.unboundmedicine.com/medline/citation/22841783/Hormone_therapy_increases_risk_of_ulcerative_colitis_but_not_Crohn's_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5085(12)01089-X DB - PRIME DP - Unbound Medicine ER -