Environmental risk factors (excluding tobacco and microorganisms): critical analysis of old and new hypotheses.
The increase in incidence in both ulcerative colitis and Crohn's disease during the 20th century has led to an abundance of different hypotheses on what sort of exposures are responsible. There has been a special focus on dietary factors, as well as on other exposures introduced on a population-based level, including fast food, cola drinks, toothpaste, antibiotics and oral contraceptives. The aim of this review is to critically assess the results from the different observational studies that have investigated these hypotheses, and also to propose research agendas that should be pursued in the future. The conclusion is that infectious exposures and early bacterial colonization, which are associated with better hygiene early in life and that influence immune function, and possibly oral contraceptives, remain the only exposures of interest for future research into the aetiology of ulcerative colitis and Crohn's disease.
Ekbom
Anders
A
Clinical Epidemiology Unit, Department of Medicine, Karolinska Hospital, M9:01, Stockholm SE-171 76, Sweden. anders.ekbom@medks.ki.se
Montgomery
Scott M
SM
D000900:Anti-Bacterial Agents / Q000009:adverse effects; D003093:Colitis, Ulcerative / Q000209:etiology*; D003276:Contraceptives, Oral / Q000009:adverse effects; D003424:Crohn Disease / Q000209:etiology*; D004032:Diet / Q000009:adverse effects; D006801:Humans; D006920:Hygiene; D012307:Risk Factors
D000900:Anti-Bacterial Agents; D003276:Contraceptives, Oral