Environmental factors in inflammatory bowel disease: A co-twin control study of a Swedish-Danish twin population

Halfvarson, Jonas; Jess, Tine; Magnuson, Anders; Montgomery, Scott; Orholm, Marianne; Tysk, Curt; Binder, Vibeke; Järnerot, Gunnar

doi:10.1097/01.mib.0000228998.29466.ac

Cited by 154 publications

(134 citation statements)

References 48 publications

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“…Finally, the Oxford Family Planning Association contraceptive study showed that the risk of developing CD in women was more than threefold higher in smokers than nonsmokers ( 168 ). In twin studies, Bridger found that in 23 dichotomous twin pairs, the smoker twin had CD in 91% of cases with an OR of 10.5 (95% CI, 2.6-92) and in another more recent study, the smoking twin from discordant pairs demonstrated an OR of 2.9 (95% CI, 1.2-7.1) ( 169 ). A meta-analysis by Mahid et al examined a total of nine studies reporting on smoking and development of CD ( 170 ).…”

Section: Summary Of Evidencementioning

confidence: 96%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

403

421

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Recent data suggest that infl ammatory bowel disease (IBD) patients do not receive preventive services at the same rate as general medical patients. Patients with IBD often consider their gastroenterologist to be the primary provider of care. To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. Gastroenterologists need to explicitly inform the primary care provider of the unique needs of the IBD patient, especially those on immunomodulators and biologics or being considered for such therapy. In particular, documentation of up to date vaccinations are crucial as IBD patients are often treated with long-term immune-suppressive therapies and may be at increased risk for infections, many of which are preventable with vaccinations. Health maintenance issues addressed in this guideline include identifi cation, safety and appropriate timing of vaccinations, screening for osteoporosis, cervical cancer, melanoma and non-melanoma skin cancer as well as identifi cation of depression and anxiety and smoking cessation. To accomplish these health maintenance goals, coordination between the primary care provider, gastroenterology team and other specialists is necessary. of evidence, we entered data from the papers of highest evidence into the GRADE program (accessible at http://www.gradepro.org ). Th e recommendation statements from this guideline are shown in Table 1 . Summary statements, when listed, are designed to be descriptive in nature without associated evidence-based ratings. VACCINATIONSRecent data suggest that IBD patients do not receive preventive services at the same rate as general medical patients ( 2 ). Members of the gastroenterology team are oft en the only clinicians that a patient with IBD will see. As such, it is incumbent upon gastroenterologists to take a proactive role in the health care needs of their IBD patients ( 3-5 ). It is crucial to clarify with the patient the limits of the specialist's responsibilities and delegate routine health care issues to the primary care clinician. It is equally important to educate the primary care clinician to the unique health maintenance needs of the IBD patient, especially those on immunomodulators and biologic agents. Although it appears that both primary care clinicians and gastroenterologists are hesitant to take ownership of vaccinations ( 6-8 ), it is reasonable ( 9 ) that vaccination recommendations be the responsibility of the treating gastroenterologist, but the actual delivery/administration of these vaccines may be a shared responsibility ( 10-13 ). Communicating specifi c recommendations to the primary care team in a concise fashion are needed. Consider empowering the patient by giving written recommendations to bring to their primary care physician. Clinicians sharing an electronic medical record should use this platform to send recommendations to the referring clinician.Patients with IBD are oft en treated with long-term immunesuppressive therapies and may t...

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Section: Summary Of Evidencementioning

confidence: 96%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

403

421

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“…The genetic influence is also supported by higher concordance rates (approximately 50%) for CD occurrence in monozygotic twins (Tysk et al, 1988;Orholm et al, 2000;Halfvarson et al, 2003;Jess et al, 2005). Still, approximately 50% of identical twin pairs are discordant for CD (that is, one is diseased and one is healthy) demonstrating that environmental factors are also important for disease incidence (Loftus, 2004;Halfvarson et al, 2006).…”

Section: Introductionmentioning

confidence: 71%

Molecular analysis of the gut microbiota of identical twins with Crohn's disease

et al. 2008

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Increasing evidence suggests that a combination of host genetics and the composition of the gut microbiota are important for development of Crohn's disease (CD). Our aim was to study identical twins with CD to determine microbial factors independent of host genetics. Fecal samples were studied from 10 monozygotic twin pairs with CD (discordant n ¼ 6 and concordant n ¼ 4) and 8 healthy twin pairs. DNA was extracted, 16S rRNA genes were PCR amplified and T-RFLP fingerprints generated using general bacterial and Bacteroides group-specific primers. The microbial communities were also profiled based on their percentage G þ C contents. Bacteroides 16S rRNA genes were cloned and sequenced from a subset of the samples. The bacterial diversity in each sample and similarity indices between samples were estimated based on the T-RFLP data using a combination of statistical approaches. Healthy individuals had a significantly higher bacterial diversity compared to individuals with CD. The fecal microbial communities were more similar between healthy twins than between twins with CD, especially when these were discordant for the disease. The microbial community profiles of individuals with ileal CD were significantly different from healthy individuals and those with colonic CD. Also, CD individuals had a lower relative abundance of B. uniformis and higher relative abundances of B. ovatus and B. vulgatus. Our results suggest that genetics and/or environmental exposure during childhood, in part, determine the gut microbial composition. However, CD is associated with dramatic changes in the gut microbiota and this was particularly evident for individuals with ileal CD.

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“…Similar observations have been made in IBD where siblings that were smokers tended to develop CD while non-smokers developed UC. [25,26] In CD, women are more affected by smoking and they have a higher relative risk, sometimes as much as three-fold [27].…”

Section: Discussionmentioning

confidence: 99%

Is smoking a risk factor for collagenous colitis?

Vigren

Sjöberg

Benoni

et al. 2011

Scandinavian Journal of Gastroenterology

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108

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Objective. The association between smoking and idiopathic inflammatory bowel disease is well known; smoking seems to have a diverse effect. Crohn´s disease is associated with smoking, while ulcerative colitis is associated with non-smoking. Data on smoking in microscopic colitis of the collagenous type (CC) is lacking. The aim of this investigation was to study smoking habits in collagenous colitis and to observe whether smoking had any impact on the course of the disease. Materials and Methods.116 patients (92 women) with median age of 62 years (IQR 55-73) answered questionnaires covering demographic data, smoking habits and disease activity. As control group we used data from the general population in Sweden retrieved from the National Statistics Office of Sweden, the central bureau for national socioeconomic information. Results. Of the 116 CC patients, 37% were smokers compared to 17 % of controls (p<0.001, OR 2.95). In the age group 16-44 years, 75 % of CC patients were smokers compared to 15 % of controls (p<0.001, OR 16.54). All CC smoker patients started smoking before the onset of disease. Furthermore, smokers developed the disease earlier than non-smokers -at 42 years of age (median) compared with 56 years in non-smokers (p<0.003). Although the proportion with active disease did not differ between smokers and non-smokers, there was a trend indicating that more smokers received active treatment (42% vs. 17%), p=0.078). Conclusions. Smoking is a risk factor for collagenous colitis. Smokers develop their disease more than ten years earlier than non-smokers.

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Environmental factors in inflammatory bowel disease: A co-twin control study of a Swedish-Danish twin population

Abstract: The observed associations indicate that markers of possible infectious events may influence the risk of IBD. Some of these effects might be mediated by long-term changes in gut flora or alterations in reactivity to the flora. The influence of smoking in IBD was confirmed.

Cited by 154 publications

References 48 publications

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Molecular analysis of the gut microbiota of identical twins with Crohn's disease

Is smoking a risk factor for collagenous colitis?

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