Hypothesis: Increased consumption of emulsifiers as an explanation for the rising incidence of Crohn's disease.
Crohn's disease (CD) incidence has increased over the past fifty years but the explanation is unclear. CD can be brought into remission by liquid enteral feeding, but the mechanism for this response is unknown. We suggest that consumption of emulsifiers in processed foods may promote CD by increasing bacterial translocation. This is supported by evidence that (i) geographical variation in CD correlates with emulsifier consumption as does the increasing incidence of CD in Japan; (ii) although CD incidence also correlates with fat consumption, the response to enteral feeding is not affected by the fat content of the feed and (iii) very small concentrations of the emulsifier polysorbate 80 enhance bacterial translocation across intestinal epithelia. Undigested emulsifiers may increase bacterial translocation, particularly in the small intestine where the mucus layer is discontinuous. The hypothesis should be testable by trials of enteral feeding with/without emulsifiers.
Department of Gastroenterology, University of Liverpool, Duncan Building, Daulby Street, L69 3GA, United Kingdom.
Carol L
CL
Roberts
Sarah L
SL
Rushworth
Emile
E
Richman
Jonathan M
JM
Rhodes
D018988:Bacterial Translocation; D003424:Crohn Disease / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D019049:Developed Countries; D004032:Diet / Q000009:adverse effects*; D045703:Emulsifying Agents / Q000009:adverse effects*; D005503:Food Additives / Q000009:adverse effects*; D014943:Global Health; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology
D045703:Emulsifying Agents; D005503:Food Additives