title: Disease severity and treatment requirements in familial inflammatory bowel disease.
abstract: OBJECTIVE
  Several studies demonstrate an increased prevalence and concordance of inflammatory bowel disease among the relatives of patients. Other studies suggest that genetic influence is over-estimated. The aims of this study are to evaluate the phenotypic expression and the treatment requirements in familial inflammatory bowel disease, to study the relationship between number of relatives and degree of kinship with disease severity and to quantify the impact of family aggregation compared to other environmental factors.
  
  
  METHODS
  Observational analytical study of 1211 patients followed in our unit. We analyzed, according to the existence of familial association, number and degree of consanguinity, the phenotypic expression, complications, extraintestinal manifestations, treatment requirements, and mortality. A multivariable analysis considering smoking habits and non-steroidal-anti-inflammatory drugs was performed.
  
  
  RESULTS
  14.2% of patients had relatives affected. Median age at diagnosis tended to be lower in the familial group, 32 vs 29, p = 0.07. In familial ulcerative colitis, there was a higher proportion of extraintestinal manifestations: peripheral arthropathy (OR = 2.3, p = 0.015) and erythema nodosum (OR = 7.6, p = 0.001). In familial Crohn's disease, there were higher treatment requirements: immunomodulators (OR = 1.8, p = 0.029); biologics (OR = 1.9, p = 0.011); and surgery (OR = 1.7, p = 0.044). The abdominal abscess increased with the number of relatives affected: 5.1% (sporadic), 7.0% (one), and 14.3% (two or more), p=0.039. These associations were maintained in the multivariate analysis.
  
  
  CONCLUSIONS
  Familial aggregation is considered a risk factor for more aggressive disease and higher treatment requirements, a tendency for earlier onset, more abdominal abscess, and extraintestinal manifestations, remaining a risk factor analyzing the influence of some environmental factors.
authors.affiliation: Digestive Disease Department, University of Valencia, University Clinic Hospital of Valencia, Blasco Ibañez Av. 17, 46010, Valencia, Spain. mapibafe@gmail.com.
authors.forename: María Pilar
authors.initials: MP
authors.lastname: Ballester
authors.affiliation: Digestive Disease Department, University of Valencia, University Clinic Hospital of Valencia, Blasco Ibañez Av. 17, 46010, Valencia, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Martí
authors.affiliation: Digestive Disease Department, University of Valencia, University Clinic Hospital of Valencia, Blasco Ibañez Av. 17, 46010, Valencia, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Tosca
authors.affiliation: Digestive Disease Department, University of Valencia, University Clinic Hospital of Valencia, Blasco Ibañez Av. 17, 46010, Valencia, Spain.
authors.forename: Marta Maia
authors.initials: MM
authors.lastname: Bosca-Watts
authors.affiliation: Digestive Disease Department, University of Valencia, University Clinic Hospital of Valencia, Blasco Ibañez Av. 17, 46010, Valencia, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Sanahuja
authors.affiliation: Digestive Disease Department, University of Valencia, University Clinic Hospital of Valencia, Blasco Ibañez Av. 17, 46010, Valencia, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Navarro
authors.affiliation: Digestive Disease Department, University of Valencia, University Clinic Hospital of Valencia, Blasco Ibañez Av. 17, 46010, Valencia, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Pascual
authors.affiliation: Digestive Disease Department, University of Valencia, University Clinic Hospital of Valencia, Blasco Ibañez Av. 17, 46010, Valencia, Spain.
authors.forename: Rosario
authors.initials: R
authors.lastname: Antón
authors.affiliation: Digestive Disease Department, University of Valencia, University Clinic Hospital of Valencia, Blasco Ibañez Av. 17, 46010, Valencia, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Mora
authors.affiliation: Digestive Disease Department, University of Valencia, University Clinic Hospital of Valencia, Blasco Ibañez Av. 17, 46010, Valencia, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Mínguez
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000473:pathology; D003424:Crohn Disease / Q000188:drug therapy / Q000473:pathology; D005190:Family; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy / Q000473:pathology* / Q000628:therapy*; D008297:Male; D015999:Multivariate Analysis; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Disease severity; Familial aggregation; Treatment requirements