title: Environmental risk factors for inflammatory bowel diseases: a review.
abstract: Inflammatory bowel diseases comprising Crohn's disease (CD) and ulcerative colitis (UC) are chronic immunologically mediated diseases. The key mechanism underlying the pathogenesis of these diseases is a dysregulated immune response to commensal flora in a genetically susceptible host. Thus intestinal microbial dysbiosis, host genetics, and the external environment all play an important role in the development of incident disease and in determining subsequent disease behavior and outcomes. There are several well-defined or putative environmental risk factors including cigarette smoking, appendectomy, diet, stress and depression, vitamin D as well as hormonal influence. The effect of some of the risk factors appears to differ between CD and UC suggesting that despite shared genetic and immunologic mechanisms, distinct pathways of pathogenesis exist. There is a growing body of literature identifying risk factors for incident disease. There is less rigorous literature defining triggers of relapse, and few controlled clinical trials examining if modification of such risk factors results in an improvement in patient outcomes. This is an area of considerable patient, physician, and scientific interest, and there is an important unmet need for rigorous studies of the external environment in disease pathogenesis and subsequent course.
authors.affiliation: Division of Gastroenterology, Massachusetts General Hospital Crohn's and Colitis Center and Harvard Medical School, 165 Cambridge Street, 9th Floor, Boston, MA, 02114, USA, aananthakrishnan@partners.org.
authors.forename: Ashwin N
authors.initials: AN
authors.lastname: Ananthakrishnan
mesh_terms: D001062:Appendectomy / Q000009:adverse effects; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D003424:Crohn Disease / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D003863:Depression / Q000150:complications; D004032:Diet / Q000009:adverse effects; D004777:Environment; D006801:Humans; D008019:Life Style; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000009:adverse effects; D013315:Stress, Psychological / Q000150:complications; D014807:Vitamin D / Q000378:metabolism
chemical_list: D014807:Vitamin D