Morris, Danielle L.; (2004) The epidemiology of inflammatory bowel disease in the United Kingdom: Early environmental associations. Doctoral thesis (M.D), UCL (University College London).

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Abstract

Aims: To examine associations between childhood environmental factors and inflammatory bowel disease. Introduction; Recent rises in incidence support environmental factors in the aetiology of inflammatory bowel disease. Studies examining environmental exposures have varying conclusions. Childhood infectious exposures have been proposed. Infections studied including measles have highly controversial conclusions. Atypical infectious patterns such as early or delayed exposure and improved hygiene are hypothesised. Methods: This study used data from the 1970 British Cohort Study, a longitudinal population based birth cohort study of 18,000 children in Great Britain, born in 1970. Data were collected prospectively aged 5, 10 and 16 years. At 26 years, cohort members were questioned about inflammatory bowel disease. Physicians confirmed diagnoses where possible and histology was independently analysed. Factors examined included demographic and perinatal factors, family history, material and cultural circumstances and specific infectious exposures (including measles, other viral infections and vaccinations). Results: The prevalence of inflammatory bowel disease aged 26 years was 49.2 per 10,000 population. 30 subjects reported Crohn's disease and 22 ulcerative colitis. Asian ethnic origins, family history of inflammatory bowel disease and childhood eczema were independent risk factors for inflammatory bowel disease. Passive smoke exposure by age 16 was associated with reduced odds for Crohn's disease. Older siblings and increased maternal parity were associated with increased odds for ulcerative colitis and reduced odds for Crohn's disease. There was no association between measles infection or measles vaccination and inflammatory bowel disease. Conclusions: The study supports the role of childhood environmental factors in inflammatory bowel disease. Measles infection and vaccination in isolation were not risk factors. Additional evidence is required to support the hypothesis that abnormal patterns of infectious exposures in childhood are risks for inflammatory bowel disease. This research should be repeated when more members have developed disease and the study power improved.

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