Allergic conditions as a risk factor for Crohn's disease and ulcerative colitis?

April 1995

Immunology, Microbiology, and Inflammatory Disorders A907

ALLERGIC CONDITIONS AS A RISK FACTOR FOR CROHN'S DISEASE AND ULCERATIVE COLITIS? M.G. Russel, J. Rijken, J. Gcedhard, E. van Wijlick', R.W. Stockbrfigger and the South Liraburg IBD Study Group, Dept. of Gastroenterology and MEMIC*, University of Lirnburg, Maastricht, The Netherlands. Allergic conditions have occasionally been mentioned as risk factors in Crohn's disease (CD) and ulcerative colitis (tiC). To investigate this hypothesis a case-control study, using mailed questionnaires, was performed. For 471 cases of CD (males 44%, median age 38 (13-83)) as well as 470 eases of UC (males 55%, median age 42 (16-87)) equal numbers of age and sex matched population controls were included in the study. Results are given as the percentage of positive findings in eases /controls and the calculated Odds Ratios (OR) with the 95% Confidence Interval. Smolfing was controlled for by logistic regression analysis. Crohn's disease CD/cont

OR

/

Ulcerative colitis UC/cont

/

OR

Atopie eczema

6 / 3%

1.9(1.0-3.8)

4 / 3%

1.3(0.6-2.0)

Hay fever

13/17%

0.7(0.5-1.0)

13/17%

0~7(0.5-1.1)

Asthma

5 / 5%

1.0(0.5-1.8)

5 / 5%

1.0(0.5-1.7)

Eczema

25/26%

0.9(0.7-1.3)

25/24%

1.1(0.8-1.4

Summary and conclusion: the results of this first ease-enntrol study do not support the hypothesis that allergic conditions are risk factors for either CD or UC. A weak association between atopic eczema and CD was found; however, the few positive eases do not suggest that it has an important role in the development of CD.

INFLAMMATORY BOWEL DISEASE QUESTIONNAIRE 0BDQ): VALIDATION AND USEFULLNESS OF A TRANSLATED, MAILED VERSION IN A DUTCH IBD POPULATION. M.G. Russel, S. Brandon, L. Engels, J. Rijken, R. Stockbrfigger, and the South Limburg IBD Study Group, Dept. of Gastroenterology, University of Limburg, Maastricht, NL. The IBDQ, a disease specific quality-of-life questionnaire, has been developed and validated in Canada (Guyatt et al., Gastroenterol 1989;96:804-10). The aims of our study were, firstly, to investigate whether a translated version of this questionnaire could be used in a Dutch IBD population and, secondly, to compare an interview with a mailed version. Patients and methggls: 97 IBD patients, 52 males and 45 females, median age 43 yeats (16 to 81), 39 with Crohn's disease (CD) and 58 with ulcerative colitis (UC) completed the Dutch IBDQ and a Visual Analogue Score (VAS) concerning disease activity, emotional function and generalwell being twice at an interval of six weeks. The second questionnaire included specific questions on change of those items. Student's T test for paired observations and linear regression analysis were used for statistical evaluation. Results: The Rgsponse rate was 100% in the interview group (n=20; 98.2% complete) compared to 94% in the mailed version (n=77; 98.5% complete). Content validity: Linear regression analysis ot the VAS and IBDQ showed a significant correlation (r values > 0.73; p < 0.005) for all categories (bowel and systemic symptoms, and emotional and social function). Resuonsiveness (sensitivity to change): In patients recording improvement or deterioration (n=33) a significant difference (p<0.005) in the total IBDQ score as well as the four subeategories of the IBDQ was observed between the two moments. Renroducibilitv: No significant difference between the two moments was observed in the 64 patients with stable disease activity. Summary and conclusion: The Dutch IBDQ was shown to be valid, responsive and ~produeible. No major differences in response and completing rates between an interview and a mailed version were observed. This questionnaire can be used in the Dutch IBD population. Our resuits suggests that it will be feasible to use translations of the IBDQ in other non-English speaking populations.

"MODERN LIFE" NUTRITIONAL FACTORS IN THE EPIDEMIOLOGY OF INFLAMMATORY BOWEL DISEASE (IBD). M.G. Russel. R. Bos, R-L Brummer, Ch. Limonard', R. Stockbriigger, and the South Limburg IBD Study Group, DeCts. of Gastroenterology and MEMIC', University of Limburg, Maastricht, The Netherlands, In the indestrialised world, the incidence rise of IBD during the last half century coincides with changes of the dietary pattern. To investigate the possible role of some characteristic "modern life" dietary factors a patient-control study was performed. To reduce recall bias, only patients with the first symptoms within the last five years were incinded. Data on average consumption of nutrients, during the five years before the first symptoms of IBD, were collected by means of a mailed quesionnaire in 159 patients with Crohn's disease (C.D), males 46 ~, median age 29 (30-73), 226 patients with ulcerative colitis CGC), median age 37 (15-81); and equal numbers of age and sex matched population controls (C) during the same period. Results are presented as % of cases/controls using the item and the Odds Ratios (OR). Crohn's disease

Cola drinks

Ulcerative colitis

% CD/con

OR05% CI)

% UC/con

OR(95% CD

67%/55%

L7 (1.1-2.7)

50%/41%

1.4 (1.0-2.0)

Chewing gum

65% /55%

1.5 (1.0-1.4)

49%/45%

1.1 (0.8-1.7)

Cin'ns fruits

70%/74%

0:9 (05-1.4)

75%/75%

1.0 (0.7-1.5)

Chocolate

66%/49%

2.0 (1.3-3.2)

56%/37%

2.1 (1.4-3.1)

Orange juice

53%/48%

1.2 (0.8-1.9)

50%/40%

1.5 (1.2-2.1)

After controlling for smoking, in CD only chocolate and cola drinks and in UC only chocolate consumption proved to be independent risk factors (logistic regression analysis). Summary and conqlusion: In this cese~control study, some of the investigated "modern life" nutritional factors were found to be possible risk factors in InD. The investigated items with high OR all share a high sugar content and reflect the changed post-war consumption pattern. In this study, confounding was reduced by use of age and sex matched population-controls and by limiting the diey,ary recall period to five years. It proved to be important to study risk factors in connection with each other.