Risk Factors of IBD

Age and Gender

IBD can occur at any age, but often people are diagnosed between the ages of 15 and 35. Most people who develop IBD are diagnosed in their adolescence or early adulthood i.e. around the 2nd to 3rd decade of life. However, some people can also develop the disease in their 50s or 60s. In general, IBD affects men and women equally.

Family History

There is an increased risk of developing IBD as compared to the general population if a family member-such as a parent or sibling also has IBD. As many as one in five people with IBD have a first-degree relative (parent, child or sibling) with the disease.

Cigarette Smoking

Smokers are more likely to develop Crohn’s disease. Cigarette smoking is an important risk factor for developing Crohn’s disease. It has been found that patients with Crohn’s disease who continue smoking are also likely to have a more severe disease which could require surgery.

Dietary Factors

An increase in the incidence of IBD in Asian countries like India has been linked to the shifts in dietary patterns with increased consumption of animal meat and processed fast foods with additives comprising of high levels of refined sugars and fats (e.g. bakery spreads, pickles, processed meats, chips, biscuits, cold drinks etc.) Diets deficient in and lacking fiber, whole grains & pulses, vegetables and fruits have also been implicated in this.

Stress

It can trigger the development of IBD and cause relapses of the disease.

Role of Medications

a. Nonsteroidal anti-inflammatory medications. (NSAIDs): These include pain killers such as ibuprofen, naproxen, acetaminophen, diclofenac, indomethacin and others. These medications increase the risk of developing IBD and may worsen the disease in people who have it.
b. Antibiotics: Their indiscriminate use without a physician’s consultation may prove to be detrimental for the intestinal microbiome and may lead to IBD.
c. Oral contraceptives and hormone replacement therapy – Their use may increase the risk for developing IBD; however, the risk appears to be small.

Sleep Deprivation

It leads to an increased risk of developing ulcerative colitis and can trigger a disease flare up in patients with IBD by affecting the body’s immune function and stress response.

Infectious Causes

Pathogens like mycobacterium/ measles virus/ listeria/ yeast/ endogenous bacteria like Bacteroides/E.coli have been proposed as predisposing factors for development of IBD.

Lack of breastfeeding

Breastfeeding helps in promoting tolerance against several microflora and food antigens which may be implicated in the development of IBD at a later stage in life and can also prevent IBD due to its favourable effects on the immune system.

Pollution

Increased risk of developing IBD is seen in patients who live in areas with greater amount of air pollution levels consisting of the particulate matter and toxic gases like sulphur dioxide and nitrous oxide.

Presence of other Autoimmune Diseases

Since IBD develops as a result of the immune dysregulation in the body such that the body starts attacking self, that is, due to the presence of autoimmune antibodies, patients with other autoimmune diseases like asthma, rheumatoid arthritis, psoriasis, multiple sclerosis, autoimmune thyroiditis, type 1 diabetes mellitus, ankylosing spondylitis have an increased susceptibility to develop IBD.

Environmental, Genetic, Microbial and Immune Factors

IBD is believed to occur as a result of the interplay of environmental, genetic, microbial and immune factors in a genetically susceptible patient. Upon exposure to an environmental trigger, he can thus develop IBD owing to his dysregulated immune system and disturbed intestinal microbiome.

Race: IBD is more common among Caucasians and Ashkenazi Jews.

Gut Infections: There is increased risk of IBD in patients with gastroenteritis (gut infection) due to complex interactions between various infective agents like viruses, bacteria especially mycobacterium species and host genetic susceptibility to IBD.

TB and CD: Due to wide spread prevalence of Gastrointestinal tuberculosis (GITB) in India, making a clear diagnosis of GITB or Crohn’s disease (CD) is very difficult and can be easily missed. So, all GITB patients should be carefully evaluated for Crohn’s disease.

Medications: Some medications like NSAIDS (non steroidal anti-inflammatory drugs), aspirin, oral contraceptives, post menopausal hormone replacement therapy and antibiotics are associated with increased relapses (re-occurrence of symptoms of IBD) or act as triggers for IBD.

Lifestyle Factors: Stress, alterations in sleep and exercise can also trigger symptoms of IBD.