Environmental Factors Affecting Inflammatory Bowel Disease: Have We Made Progress?

被引:85
作者
Lakatos, Peter Laszlo [1 ]
机构
[1] Semmelweis Univ, Dept Med 1, HU-1083 Budapest, Hungary
关键词
Inflammatory bowel disease; Ulcerative colitis; Crohn's disease; Environmental factors; Smoking; Gut flora; LONG-TERM COURSE; CROHNS-DISEASE; ULCERATIVE-COLITIS; CIGARETTE-SMOKING; CLINICAL-COURSE; RISK-FACTORS; MYCOBACTERIUM-PARATUBERCULOSIS; CHILDHOOD HYGIENE; DOMESTIC HYGIENE; PASSIVE SMOKING;
D O I
10.1159/000228553
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
The pathogenesis of inflammatory bowel disease (IBD) is only partially understood; various environmental and host (e.g. genetic, epithelial, immune, and nonimmune) factors are involved. The critical role for environmental factors is strongly supported by recent worldwide trends in IBD epidemiology. One important environmental factor is smoking. A meta-analysis partially confirms previous findings that smoking was found to be protective against ulcerative colitis and, after the onset of the disease, might improve its course, decreasing the need for colectomy. In contrast, smoking increases the risk of developing Crohn's disease and aggravates its course. The history of IBD is dotted by cyclic reports on the isolation of specific infectious agents responsible for Crohn's disease or ulcerative colitis. The more recently published cold chain hypothesis is providing an even broader platform by linking dietary factors and microbial agents. An additional, recent theory has suggested a breakdown in the balance between putative species of 'protective' versus 'harmful' intestinal bacteria - this concept has been termed dysbiosis resulting in decreased bacterial diversity. Other factors such as oral contraceptive use, appendectomy, dietary factors (e.g. refined sugar, fat, and fast food), perinatal events, and childhood infections have also been associated with both diseases, but their role is more controversial. Nonetheless, there is no doubt that economic development, leading to improved hygiene and other changes in lifestyle ('westernized lifestyle') may play a role in the increase in IBD. This review article focuses on the role of environmental factors in the pathogenesis and progression of IBDs. Copyright (C) 2009 S. Karger AG, Basel
引用
收藏
页码:215 / 225
页数:11
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