title: Environmental factors in a population-based inception cohort of inflammatory bowel disease patients in Europe--an ECCO-EpiCom study.
abstract: OBJECTIVE
  The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe possibly due to changes in environmental factors towards a more "westernised" standard of living. The aim of this study was to investigate differences in exposure to environmental factors prior to diagnosis in Eastern and Western European IBD patients.
  
  
  METHODS
  The EpiCom cohort is a population-based, prospective inception cohort of 1560 unselected IBD patients from 31 European countries covering a background population of 10.1 million. At the time of diagnosis patients were asked to complete an 87-item questionnaire concerning environmental factors.
  
  
  RESULTS
  A total of 1182 patients (76%) answered the questionnaire, 444 (38%) had Crohn's disease (CD), 627 (53%) ulcerative colitis (UC), and 111 (9%) IBD unclassified. No geographic differences regarding smoking status, caffeine intake, use of oral contraceptives, or number of first-degree relatives with IBD were found. Sugar intake was higher in CD and UC patients from Eastern Europe than in Western Europe while fibre intake was lower (p<0.01). Daily consumption of fast food as well as appendectomy before the age of 20 was more frequent in Eastern European than in Western European UC patients (p<0.01). Eastern European CD and UC patients had received more vaccinations and experienced fewer childhood infections than Western European patients (p<0.01).
  
  
  CONCLUSIONS
  In this European population-based inception cohort of unselected IBD patients, Eastern and Western European patients differed in environmental factors prior to diagnosis. Eastern European patients exhibited higher occurrences of suspected risk factors for IBD included in the Western lifestyle.
authors: Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark. Electronic address: burisch@dadlnet.dk.
authors: J
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authors: Burisch
authors: Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark.
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authors: Pedersen
authors: Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.
authors: S
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authors: Cukovic-Cavka
authors: Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.
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authors: Nicosia Private Practice, Nicosia, Cyprus.
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authors: Kaimakliotis
authors: IBD Center ISCARE, Charles University, Prague, Czech Republic.
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authors: Duricova
authors: IBD Center ISCARE, Charles University, Prague, Czech Republic.
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authors: Bortlik
authors: Gastroenterology Department, Hospital České Budějovice, České Budějovice, Czech Republic.
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authors: Department of Medicine, Amager Hospital, Amager, Denmark.
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authors: Department of Medicine, Amager Hospital, Amager, Denmark.
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authors: Thorsgaard
authors: Medical Department, Viborg Regional Hospital, Viborg, Denmark.
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authors: Krabbe
authors: Medical Department, Viborg Regional Hospital, Viborg, Denmark; Organ Centre, Hospital of Southern Jutland, Aabenraa, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
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authors: Andersen
authors: Department of Medicine V (Hepatology and Gastroenterology), Aarhus University Hospital, Arhus, Denmark.
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authors: Dahlerup
authors: Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark.
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authors: Kjeldsen
authors: Division of Endocrinology and Gastroenterology, Tartu University Hospital, Tartu, Estonia.
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authors: 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, University Hospital, Ioannina, Greece.
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authors: Katsanos
authors: 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, University Hospital, Ioannina, Greece.
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authors: Tsianos
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authors: Ladefoged
authors: 1st Department of Medicine, Semmelweis University, Budapest, Hungary.
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authors: Lakatos
authors: Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland.
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authors: Ragnarsson
authors: Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland.
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authors: Björnsson
authors: Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland.
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authors: Bailey
authors: Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland.
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authors: O'Morain
authors: Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel.
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authors: Schwartz
authors: Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel.
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authors: Odes
authors: Gastroenterology Unit, Careggi Hospital, Florence, Italy.
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authors: Giannotta
authors: U.O. Gastroenterologia, Azienda Ospedaliera - Università di Padova, Padova, Italy.
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authors: Girardin
authors: Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania.
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authors: Kiudelis
authors: Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors: L
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authors: Kupcinskas
authors: Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova.
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authors: Turcan
authors: Hospital de Vale de Sousa, Porto, Portugal.
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authors: Barros
authors: Department of Gastroenterology, Hospital de São João, Porto, Portugal; Institute of Pharmacology and Therapeutics, Oporto Medical School, Porto, Portugal; Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal.
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authors: Magro
authors: Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania.
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authors: Lazar
authors: Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania.
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authors: Goldis
authors: Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation.
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authors: Nikulina
authors: Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation.
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authors: Belousova
authors: Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain.
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authors: Martinez-Ares
authors: Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain.
authors: V
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authors: Hernandez
authors: Division of Gastroenterology and Hepatology, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology/UHL, County Council of Östergötland, Linköping, Sweden.
authors: S
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authors: Almer
authors: Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
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authors: Zhulina
authors: Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
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authors: Halfvarson
authors: St. Mark's Hospital, Imperial College London, London, UK.
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authors: Arebi
authors: Hull and East Yorkshire NHS Trust, Hull and York Medical School, Hull Royal Infirmary, Hull, UK.
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authors: Tsai
authors: Hull and East Yorkshire NHS Trust, Hull and York Medical School, Hull Royal Infirmary, Hull, UK.
authors: S
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authors: Sebastian
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authors: PL
authors: Lakatos
authors: Department of Medical Gastroenterology, Gentofte Hospital, Copenhagen, Denmark.
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authors: Langholz
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mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000706:statistics & numerical data; D003093:Colitis, Ulcerative / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D003424:Crohn Disease / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D004043:Dietary Fiber / Q000706:statistics & numerical data; D019422:Dietary Sucrose; D005060:Europe / Q000453:epidemiology; D057140:Fast Foods / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008457:Measles / Q000453:epidemiology; D008875:Middle Aged; D009107:Mumps / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000706:statistics & numerical data; D014917:Whooping Cough / Q000453:epidemiology; D055815:Young Adult
chemical_list: D004043:Dietary Fiber; D019422:Dietary Sucrose
keywords: Environmental factors; Inception cohort; Inflammatory bowel disease; Population-based