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Environmental factors associated with biological use and surgery in Inflammatory Bowel Disease.

J Gastroenterol Hepatol. 2020 Aug 24;:

Authors: van der Sloot KWJ, Geertsema P, Rijkmans HC, Voskuil MD, van Dullemen HM, Visschedijk MC, Festen EAM, Weersma RK, Alizadeh BZ, Dijkstra G

Abstract
BACKGROUND: While major efforts were made studying the complex etiology of IBD including environmental factors, less is known about underlying causes leading to the heterogeneous and highly variable course of disease. As cigarette smoking cessation is the best-known environmental factor with beneficial effect in Crohn’s disease (CD), more exposome factors are likely involved. Further insights into the role of the exposome in heterogeneity of disease might not only further knowledge of underlying pathways, but also allow for better risk stratification.
METHODS: 728 IBD patients completed the validated Groningen IBD Environmental Questionnaire (GIEQ), collecting exposome data for 93 exposome factors. Associations with disease course, i.e. for need for surgery or biological therapy were evaluated using univariate and multivariate-adjusted logistic regression modeling.
RESULTS: No significant associations were seen after Bonferroni correction. However, eleven novel exposome factors were identified with P<0.05. Two factors were associated with course of CD and UC; beer (CD OR0.3/UC OR0.3) and cannabis (0.5/2.2). While in CD carpet flooring (0.5) was associated with biological use, four factors were associated with surgery; working shifts (1.8), appendectomy (2.4), frequent tooth brushing (2.8) and large household size (0.1). For UC, migrants more often required biologicals (10.2). Childhood underweight (3.4), amphetamine use (6.2) and cocaine use (4.8) were associated with surgery. Five factors were replicated.
CONCLUSIONS: We identified sixteen environmental factors nominally associated with biological use and surgery in established IBD. These new insights form an important stepping stone to guide research on biological pathways involved, risk stratification, tailor-made interventions and preventive strategies in IBD.

PMID: 32839987 [PubMed – as supplied by publisher]

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