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Environmental Factors in Romanian and Belgian Patients with Inflammatory Bowel Disease – a Retrospective Comparative Study
Carmen Monica PREDA, Teodora MANUC, Doina ISTRATESCU, Edouard LOUIS, Cristian BAICUS, Irina SANDRA, Mircea DICULESCU, Catherine REENAERS, Catherine van KEMSEKE, Maria NITESCU, Cristian TIERANU, Corina Georgiana SANDU, Gabriela OPREA-CALIN, Letitia TUGUI, Siyana VIZIRU, Cosmin-Alexandru CIORA, Liliana-Simona GHEORGHE and Mircea MANUC
ABSTRACT
Background: Several environmental factors have been associated with onset of inflammatory bowel diseases (IBD): smoking, hygiene, microorganisms, oral contraceptive pills (OCPs), non-steroid anti-inflammatory drugs, antibiotics, appendectomy, diet, breastfeeding, vitamin D, stress and ambient air pollution. The aim of this study was to investigate the prevalence of these factors in a Romanian and Belgian population with IBD.
Material and methods: A total of 129 patients with an IBD diagnosis (76 from Romania and 53 from Belgium) participated in an interview and were asked to fill in a questionnaire regarding environmental factors before and after the onset of IBD; 35 Romanian and 21 Belgian healthy individuals constituted the control group.
Results: A total of 40 patients with ulcerative colitis (UC) and 89 with Crohn’s disease (CD) were included. Gender distribution was 43% males and 57% females. They had a median age of 42 years (range between 19-74 years), a median disease duration of eight years and 79% were in clinical remission. Both Romanian and Belgian IBD patients reported an increased antibiotic consumption before IBD onset compared to controls: 58% vs 10% (p<0.001) and 51% vs 5% (p<0.001), respectively. Belgian IBD patients declared significantly more frequent OCP use (53% vs 9%, p <0.001), they were breastfed in a lower proportion (49% vs 76%, p <0.001) and had experienced a higher level of psychosocial stress (p<0.001).
Conclusions: Antibiotic consumption before IBD onset may play a pivotal role in IBD development in both Romanian and Belgian populations. In Belgian patients, OCP consumption, a higher level of psychosocial stress and lack of breastfeeding may also be involved.
Keywords: inflammatory bowel disease, Crohn’s disease, ulcerative colitis, environmental factors, antibiotics, breastfeeding, OCP consumption, psychosocial stress