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Françoise Railhet
Manager of the LLL France Medical Associates Program
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Gut. 2005 Mar;54(3):357-63.
Environmental risk factors in paediatric inflammatory bowel diseases: a
population based case control study.
Baron S, Turck D, Leplat C, Merle V, Gower-Rousseau C, Marti R, Yzet T,
Lerebours E, Dupas JL, Debeugny S, Salomez JL, Cortot A, Colombel JF.
Registre des Maladies Inflammatoires Chroniques de l'Intestin (EPIMAD),
Service
d'Epidemiologie et de Sante Publique, Hopital Calmette, Lille, France.
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.
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