Gastroenterology

Gastroenterology

Volume 126, Issue 6, May 2004, Pages 1504-1517
Gastroenterology

Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences

https://doi.org/10.1053/j.gastro.2004.01.063Get rights and content

Abstract

Although the incidence and prevalence of ulcerative colitis and Crohn’s disease are beginning to stabilize in high-incidence areas such as northern Europe and North America, they continue to rise in low-incidence areas such as southern Europe, Asia, and much of the developing world. As many as 1.4 million persons in the United States and 2.2 million persons in Europe suffer from these diseases. Previously noted racial and ethnic differences seem to be narrowing. Differences in incidence across age, time, and geographic region suggest that environmental factors significantly modify the expression of Crohn’s disease and ulcerative colitis. The strongest environmental factors identified are cigarette smoking and appendectomy. Whether other factors such as diet, oral contraceptives, perinatal/childhood infections, or atypical mycobacterial infections play a role in expression of inflammatory bowel disease remains unclear. Additional epidemiologic studies to define better the burden of illness, explore the mechanism of association with environmental factors, and identify new risk factors are needed.

Section snippets

Descriptive epidemiology

Descriptive epidemiology is the study of disease incidence, prevalence, and demographic factors such as age, gender, and race or ethnic group. Variations of incidence and prevalence of disease across age, gender, race, geographic region, or time may yield clues to the etiology of disease or at least identify areas that deserve further scrutiny. Moreover, studies of incidence and prevalence provide valuable information about the burden of illness to policy makers, funding agencies, resource

Cigarette smoking

Since the first widely publicized report of an inverse association between ulcerative colitis and cigarette smoking,58 many studies have confirmed this unusual finding59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74 (Table 3). The odds ratio for developing ulcerative colitis among current smokers is consistently less than 1; stated another way, current smokers seem to have a significantly decreased risk of ulcerative colitis. A 1989 meta-analysis noted that current smokers are

Conclusion

Despite years of investigation, the root causes of IBD are yet to be identified. Descriptive epidemiologic studies not only provide valuable information about the burden of illness, they highlight differences in incidence of IBD across age, time, and geographic region, suggesting that environmental factors can significantly modify the expression of these conditions. The strongest modifying factors identified thus far include family history of IBD, cigarette smoking, and appendectomy. Continued

References (177)

  • I Carr et al.

    The effects of migration on ulcerative colitisa three-year prospective study among Europeans and first- and second-generation South Asians in Leicester (1991–1994)

    Am J Gastroenterol

    (1999)
  • M.V Tobin et al.

    Cigarette smoking and inflammatory bowel disease

    Gastroenterology

    (1987)
  • M.D Silverstein et al.

    Cigarette smoking and ulcerative colitisa case-control study

    Mayo Clin Proc

    (1994)
  • S Reif et al.

    Lack of association between smoking and Crohn’s disease but the usual association with ulcerative colitis in Jewish patients in Israela multicenter study

    Am J Gastroenterol

    (2000)
  • E.V Loftus et al.

    Primary sclerosing cholangitis is associated with nonsmoking—a case-control study

    Gastroenterology

    (1996)
  • K.J van Erpecum et al.

    Risk of primary sclerosing cholangitis is associated with nonsmoking behavior

    Gastroenterology

    (1996)
  • L Beaugerie et al.

    Impact of cessation of smoking on the course of ulcerative colitis

    Am J Gastroenterol

    (2001)
  • S Reif et al.

    Lack of association between smoking and inflammatory bowel disease in Jewish patients in Israel

    Gastroenterology

    (1995)
  • M.F Picco et al.

    Tobacco consumption and disease duration are associated with fistulizing and stricturing behaviors in the first 8 years of Crohn’s disease

    Am J Gastroenterol

    (2003)
  • L.R Sutherland et al.

    Effect of cigarette smoking on recurrence of Crohn’s disease

    Gastroenterology

    (1990)
  • A Timmer et al.

    Oral contraceptive use and smoking are risk factors for relapse in Crohn’s disease

    Gastroenterology

    (1998)
  • D.K Podolsky

    Inflammatory bowel disease

    N Engl J Med

    (2002)
  • M Orholm et al.

    Concordance of inflammatory bowel disease among Danish twins—results of a nationwide study

    Scand J Gastroenterol

    (2000)
  • W Daiss et al.

    Epidemiology of inflammatory bowel disease in the county of Tubingen (West Germany)

    Scand J Gastroenterol Suppl

    (1989)
  • F Roin et al.

    Inflammatory bowel disease of the Faroe Islands, 1981–1988. A prospective epidemiologic studyprimary report

    Scand J Gastroenterol Suppl

    (1989)
  • L Halme et al.

    The incidence of Crohn’s disease in the Helsinki metropolitan area during 1975–1985

    Ann Chir Gynaecol

    (1989)
  • E Langholz et al.

    Incidence and prevalence of ulcerative colitis in Copenhagen county from 1962 to 1987

    Scand J Gastroenterol

    (1991)
  • P Munkholm et al.

    Incidence and prevalence of Crohn’s disease in the county of Copenhagen, 1962–87a sixfold increase in incidence

    Scand J Gastroenterol

    (1992)
  • C Gower-Rousseau et al.

    Incidence of inflammatory bowel disease in northern France (1988–1990)

    Gut

    (1994)
  • J Stewenius et al.

    Ulcerative colitis and indeterminate colitis in the city of Malmo, Sweden. A 25-year incidence study

    Scand J Gastroenterol

    (1995)
  • B Moum et al.

    Incidence of Crohn’s disease in four counties in southeastern Norway, 1990–93. A prospective population-based study

    Scand J Gastroenterol

    (1996)
  • B Moum et al.

    Incidence of ulcerative colitis and indeterminate colitis in four counties of southeastern Norway, 1990–93. A prospective population-based study

    Scand J Gastroenterol

    (1996)
  • S Shivananda et al.

    Incidence of inflammatory bowel disease across Europeis there a difference between north and south? Results of the European Collaborative Study on Inflammatory Bowel Disease (EC-IBD)

    Gut

    (1996)
  • A Lapidus et al.

    Incidence of Crohn’s disease in Stockholm County 1955–1989

    Gut

    (1997)
  • M.G Russel et al.

    High incidence of inflammatory bowel disease in The Netherlandsresults of a prospective study

    Dis Colon Rectum

    (1998)
  • S Bjornsson et al.

    Inflammatory bowel disease in Iceland, 1980–89. A retrospective nationwide epidemiologic study

    Scand J Gastroenterol

    (1998)
  • S Bjornsson et al.

    Inflammatory bowel disease in Iceland, 1990–1994a prospective, nationwide, epidemiological study

    Eur J Gastroenterol Hepatol

    (2000)
  • S.M Montgomery et al.

    Prevalence of inflammatory bowel disease in British 26 year oldsnational longitudinal birth cohort

    BMJ

    (1998)
  • T.R Yapp et al.

    Crohn’s disease incidence in Cardiff from 1930an update for 1991–1995

    Eur J Gastroenterol Hepatol

    (2000)
  • G.P Rubin et al.

    Inflammatory bowel diseaseepidemiology and management in an English general practice population

    Aliment Pharmacol Ther

    (2000)
  • B.R Pinchbeck et al.

    Inflammatory bowel disease in northern Alberta. An epidemiologic study

    J Clin Gastroenterol

    (1988)
  • R.A Hiatt et al.

    Epidemiology of inflammatory bowel disease in a defined northern California population

    West J Med

    (1988)
  • J.H Kurata et al.

    Crohn’s disease among ethnic groups in a large health maintenance organization

    Gastroenterology

    (1992)
  • C.N Bernstein et al.

    Epidemiology of Crohn’s disease and ulcerative colitis in a central Canadian provincea population-based study

    Am J Epidemiol

    (1999)
  • E.V Loftus et al.

    Ulcerative colitis in Olmsted County, Minnesota, 1940–1993incidence, prevalence, and survival

    Gut

    (2000)
  • J.F Blanchard et al.

    Small-area variations and sociodemographic correlates for the incidence of Crohn’s disease and ulcerative colitis

    Am J Epidemiol

    (2001)
  • B Vucelic et al.

    Epidemiology of Crohn’s disease in Zagreb, Yugoslaviaa ten-year prospective study

    Intl J Epidemiol

    (1991)
  • B Vucelic et al.

    Ulcerative colitis in Zagreb, Yugoslaviaincidence and prevalence 1980–1989

    Intl J Epidemiol

    (1991)
  • J Mate-Jimenez et al.

    Incidence and prevalence of ulcerative colitis and Crohn’s disease in urban and rural areas of Spain from 1981 to 1988

    J Clin Gastroenterol

    (1994)
  • O.N Manousos et al.

    A prospective epidemiologic study of Crohn’s disease in Heraklion, Crete. Incidence over a 5-year period

    Scand J Gastroenterol

    (1996)
  • Cited by (0)

    1

    Dr. Loftus has served as a consultant for AstraZeneca and Novartis and has received research support from AstraZeneca, Procter and Gamble, and GlaxoSmithKline.

    View full text