Risk of Inflammatory Bowel Disease Lower In Rural Households

MedicalResearch.com Interview with:

Eric I. Benchimol, MD, PhD, FRCPC Associate Professor of Pediatrics and Epidemiology, University of Ottawa Division of Gastroenterology, Hepatology and Nutrition Children's Hospital of Eastern Ontario Ottawa, ON Canada

Dr. Benchimol

Eric I. Benchimol, MD, PhD, FRCPC
Associate Professor of Pediatrics and Epidemiology, University of Ottawa
Division of Gastroenterology, Hepatology and Nutrition
Children’s Hospital of Eastern Ontario
Ottawa, ON Canada

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We found that living in a rural household (compared to urban households) was protective against developing inflammatory bowel disease (IBD). People living in a rural household were around 10% less likely to get IBD (Crohn’s disease and ulcerative colitis).

While our finding that IBD was more common in people living in urban households was similar to other studies from around the world, there were a number of new, interesting findings:

  1. Living in a rural household was most protective against pediatric-onset IBD. In fact, it was not protective in IBD with onset between ages 18-39, 40-64, or 65 and older at diagnosis.
  2. Living in a rural household in the first 5 years of life was highly protective against IBD later in life.

These findings indicate the importance of early life environmental exposures in the subsequent development of IBD. This effect has been seen in the inflammatory bowel disease literature when examining other environmental risk factors, particularly early-life antibiotic use and air pollution. These risk factors seem to have the strongest effect of increasing the risk of childhood-onset IBD, and not adult-onset disease.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: Inflammatory bowel disease (Crohn’s and ulcerative colitis) is extremely common in the Western world, and Canada has one of the highest rates in the world. In addition, we are seeing far more cases in childhood than we did 20-30 years ago. While many factors may contribute to these changing trends, one factor may be the increased urbanization of Canadian households. Urban lifestyle may lead to fewer exposures to certain bacteria, changing the intestinal microbiome in genetically susceptible individuals, resulting in increased risk of IBD. Physicians must be aware of the presentation of pediatric IBD (which can differ from adult IBD), because it has become increasingly common. Scientists must continue work to find the cause of Crohn’s and colitis and ways in which we can prevent these chronic diseases.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: If we fully understood the environmental risk factors that increase the risk of IBD, we should be able to intervene to alter these risk factors and prevent Crohn’s and colitis in people who were at higher risk (such as first-degree relatives of IBD patients, or those with specific genes). Our findings indicate that if we were to intervene, we would probably provide the greatest benefit to altering exposure to these risk factors early in life, rather than in adulthood.

Our findings also have research implications. The current main hypothesis regarding the cause of IBD is that environmental risk factors change the intestinal microbiome in genetically at-risk individuals, causing an increased risk of later developing IBD. The microbiome is thought to be established very early in life (probably the first 2-3 years of life), and is difficult to change permanently beyond that point. Therefore, our study implies that we should focus our research efforts on understanding the changes in the microbiome of young children early in life, and at the time of diagnosis with IBD, to better develop treatments that might bring the microbiome back to a normal or healthy state.

MedicalResearch.com: Is there anything else you would like to add?

Response: For more information, please visit the website of the Canadian Gastro-Intestinal Epidemiology Consortium (http://cangiec.ca). No conflicts of interest to disclose. 

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation: Eric I Benchimol, Gilaad G Kaplan, Anthony R Otley, Geoffrey C Nguyen, Fox E Underwood, Astrid Guttmann, Jennifer L Jones, Beth K Potter, Christina A Catley, Zoann J Nugent, Yunsong Cui, Divine Tanyingoh, Nassim Mojaverian, Alain Bitton, Matthew W Carroll, Jennifer deBruyn, Trevor J B Dummer, Wael El-Matary, Anne M Griffiths, Kevan Jacobson, M Ellen Kuenzig, Desmond Leddin, Lisa M Lix, David R Mack, Sanjay K Murthy, Juan Nicolás Peña Sánchez, Harminder Singh, Laura E Targownik, Maria Vutcovici, Charles N Bernstein. Rural and Urban Residence During Early Life is Associated with a Lower Risk of Inflammatory Bowel Disease: A Population-Based Inception and Birth Cohort Study. The American Journal of Gastroenterology, 2017; DOI: 10.1038/AJG.2017.208

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Last Updated on July 28, 2017 by Marie Benz MD FAAD