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Environmental factors in a population-based inception cohort of inflammatory bowel disease patients in Europe--an ECCO-EpiCom study.

Abstract

BACKGROUND AND AIMS

The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe possibly due to changes in environmental factors towards a more "westernised" standard of living. The aim of this study was to investigate differences in exposure to environmental factors prior to diagnosis in Eastern and Western European IBD patients.

METHODS

The EpiCom cohort is a population-based, prospective inception cohort of 1560 unselected IBD patients from 31 European countries covering a background population of 10.1 million. At the time of diagnosis patients were asked to complete an 87-item questionnaire concerning environmental factors.

RESULTS

A total of 1182 patients (76%) answered the questionnaire, 444 (38%) had Crohn's disease (CD), 627 (53%) ulcerative colitis (UC), and 111 (9%) IBD unclassified. No geographic differences regarding smoking status, caffeine intake, use of oral contraceptives, or number of first-degree relatives with IBD were found. Sugar intake was higher in CD and UC patients from Eastern Europe than in Western Europe while fibre intake was lower (p<0.01). Daily consumption of fast food as well as appendectomy before the age of 20 was more frequent in Eastern European than in Western European UC patients (p<0.01). Eastern European CD and UC patients had received more vaccinations and experienced fewer childhood infections than Western European patients (p<0.01).

CONCLUSIONS

In this European population-based inception cohort of unselected IBD patients, Eastern and Western European patients differed in environmental factors prior to diagnosis. Eastern European patients exhibited higher occurrences of suspected risk factors for IBD included in the Western lifestyle.

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  • Authors+Show Affiliations

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    Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark. Electronic address: burisch@dadlnet.dk.

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    Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark.

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    Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.

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    Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.

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    Nicosia Private Practice, Nicosia, Cyprus.

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    IBD Center ISCARE, Charles University, Prague, Czech Republic.

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    IBD Center ISCARE, Charles University, Prague, Czech Republic.

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    Gastroenterology Department, Hospital České Budějovice, České Budějovice, Czech Republic.

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    Department of Medicine, Amager Hospital, Amager, Denmark.

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    Department of Medicine, Amager Hospital, Amager, Denmark.

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    Department of Medicine, Herning Central Hospital, Herning, Denmark.

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    Medical Department, Viborg Regional Hospital, Viborg, Denmark.

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    Medical Department, Viborg Regional Hospital, Viborg, Denmark; Organ Centre, Hospital of Southern Jutland, Aabenraa, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.

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    Department of Medicine V (Hepatology and Gastroenterology), Aarhus University Hospital, Arhus, Denmark.

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    Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark.

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    Division of Endocrinology and Gastroenterology, Tartu University Hospital, Tartu, Estonia.

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    Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands.

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    Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands.

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    Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.

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    Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.

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    1st Division of Internal Medicine and Hepato-Gastroenterology Unit, University Hospital, Ioannina, Greece.

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    1st Division of Internal Medicine and Hepato-Gastroenterology Unit, University Hospital, Ioannina, Greece.

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    Medical Department, Dronning Ingrids Hospital, Nuuk, Greenland.

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    1st Department of Medicine, Semmelweis University, Budapest, Hungary.

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    Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland.

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    Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland.

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    Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland.

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    Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland.

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    Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel.

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    Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel.

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    Gastroenterology Unit, Careggi Hospital, Florence, Italy.

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    U.O. Gastroenterologia, Azienda Ospedaliera - Università di Padova, Padova, Italy.

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    Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania.

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    Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania.

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    Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova.

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    Hospital de Vale de Sousa, Porto, Portugal.

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    Department of Gastroenterology, Hospital de São João, Porto, Portugal; Institute of Pharmacology and Therapeutics, Oporto Medical School, Porto, Portugal; Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal.

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    Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania.

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    Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania.

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    Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation.

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    Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation.

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    Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain.

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    Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain.

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    Division of Gastroenterology and Hepatology, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology/UHL, County Council of Östergötland, Linköping, Sweden.

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    Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.

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    Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden.

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    St. Mark's Hospital, Imperial College London, London, UK.

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    Hull and East Yorkshire NHS Trust, Hull and York Medical School, Hull Royal Infirmary, Hull, UK.

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    Hull and East Yorkshire NHS Trust, Hull and York Medical School, Hull Royal Infirmary, Hull, UK.

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    1st Department of Medicine, Semmelweis University, Budapest, Hungary.

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    Department of Medical Gastroenterology, Gentofte Hospital, Copenhagen, Denmark.

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    Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark.

    Source

    Journal of Crohn's & colitis 8:7 2014 Jul pg 607-16

    MeSH

    Adolescent
    Adult
    Aged
    Aged, 80 and over
    Appendectomy
    Colitis, Ulcerative
    Crohn Disease
    Dietary Fiber
    Dietary Sucrose
    Europe
    Fast Foods
    Female
    Hospitalization
    Humans
    Male
    Measles
    Middle Aged
    Mumps
    Prospective Studies
    Risk Factors
    Severity of Illness Index
    Surveys and Questionnaires
    Vaccination
    Whooping Cough
    Young Adult

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    24315795

    Citation

    Burisch, J, et al. "Environmental Factors in a Population-based Inception Cohort of Inflammatory Bowel Disease Patients in Europe--an ECCO-EpiCom Study." Journal of Crohn's & Colitis, vol. 8, no. 7, 2014, pp. 607-16.
    Burisch J, Pedersen N, Cukovic-Cavka S, et al. Environmental factors in a population-based inception cohort of inflammatory bowel disease patients in Europe--an ECCO-EpiCom study. J Crohns Colitis. 2014;8(7):607-16.
    Burisch, J., Pedersen, N., Cukovic-Cavka, S., Turk, N., Kaimakliotis, I., Duricova, D., ... Munkholm, P. (2014). Environmental factors in a population-based inception cohort of inflammatory bowel disease patients in Europe--an ECCO-EpiCom study. Journal of Crohn's & Colitis, 8(7), pp. 607-16. doi:10.1016/j.crohns.2013.11.021.
    Burisch J, et al. Environmental Factors in a Population-based Inception Cohort of Inflammatory Bowel Disease Patients in Europe--an ECCO-EpiCom Study. J Crohns Colitis. 2014;8(7):607-16. PubMed PMID: 24315795.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Environmental factors in a population-based inception cohort of inflammatory bowel disease patients in Europe--an ECCO-EpiCom study. AU - Burisch,J, AU - Pedersen,N, AU - Cukovic-Cavka,S, AU - Turk,N, AU - Kaimakliotis,I, AU - Duricova,D, AU - Bortlik,M, AU - Shonová,O, AU - Vind,I, AU - Avnstrøm,S, AU - Thorsgaard,N, AU - Krabbe,S, AU - Andersen,V, AU - Dahlerup,J F, AU - Kjeldsen,J, AU - Salupere,R, AU - Olsen,J, AU - Nielsen,K R, AU - Manninen,P, AU - Collin,P, AU - Katsanos,K H, AU - Tsianos,E V, AU - Ladefoged,K, AU - Lakatos,L, AU - Ragnarsson,G, AU - Björnsson,E, AU - Bailey,Y, AU - O'Morain,C, AU - Schwartz,D, AU - Odes,S, AU - Giannotta,M, AU - Girardin,G, AU - Kiudelis,G, AU - Kupcinskas,L, AU - Turcan,S, AU - Barros,L, AU - Magro,F, AU - Lazar,D, AU - Goldis,A, AU - Nikulina,I, AU - Belousova,E, AU - Martinez-Ares,D, AU - Hernandez,V, AU - Almer,S, AU - Zhulina,Y, AU - Halfvarson,J, AU - Arebi,N, AU - Tsai,H H, AU - Sebastian,S, AU - Lakatos,P L, AU - Langholz,E, AU - Munkholm,P, AU - ,, Y1 - 2013/12/07/ PY - 2013/08/24/received PY - 2013/11/15/revised PY - 2013/11/18/accepted PY - 2013/12/10/entrez PY - 2013/12/10/pubmed PY - 2015/2/13/medline KW - Environmental factors KW - Inception cohort KW - Inflammatory bowel disease KW - Population-based SP - 607 EP - 16 JF - Journal of Crohn's & colitis JO - J Crohns Colitis VL - 8 IS - 7 N2 - BACKGROUND AND AIMS: The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe possibly due to changes in environmental factors towards a more "westernised" standard of living. The aim of this study was to investigate differences in exposure to environmental factors prior to diagnosis in Eastern and Western European IBD patients. METHODS: The EpiCom cohort is a population-based, prospective inception cohort of 1560 unselected IBD patients from 31 European countries covering a background population of 10.1 million. At the time of diagnosis patients were asked to complete an 87-item questionnaire concerning environmental factors. RESULTS: A total of 1182 patients (76%) answered the questionnaire, 444 (38%) had Crohn's disease (CD), 627 (53%) ulcerative colitis (UC), and 111 (9%) IBD unclassified. No geographic differences regarding smoking status, caffeine intake, use of oral contraceptives, or number of first-degree relatives with IBD were found. Sugar intake was higher in CD and UC patients from Eastern Europe than in Western Europe while fibre intake was lower (p<0.01). Daily consumption of fast food as well as appendectomy before the age of 20 was more frequent in Eastern European than in Western European UC patients (p<0.01). Eastern European CD and UC patients had received more vaccinations and experienced fewer childhood infections than Western European patients (p<0.01). CONCLUSIONS: In this European population-based inception cohort of unselected IBD patients, Eastern and Western European patients differed in environmental factors prior to diagnosis. Eastern European patients exhibited higher occurrences of suspected risk factors for IBD included in the Western lifestyle. SN - 1876-4479 UR - https://www.unboundmedicine.com/medline/citation/24315795/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S1873-9946(13)00410-8 DB - PRIME DP - Unbound Medicine ER -