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Tuesday, 3 December 2013

Colitis - The Risk Factors

Colitis is defined as a condition of inflammation of the large intestine, including the colon, caecum and rectum.
Risk factor
1. Medical conditions
a. Ischemic colitis is the most common type of intestinal ischemia and has a clinical spectrum of injury that ranges from mild and transient ischemia to acute fulminant colitis. Patients with medicals condition such as hypertension, diabetes, hyperlipidemia, and atrial fibrillation are associated with increased risk to develop ischemic colitis(IC), according to the study by Beijing Hospital, Ministry of Health(16)

b.. Ischemic colitis is one of the most often seen disorders of the large intestine in the elderly. Common predisposing factors are atherosclerosis, shock, and congestive heart failure, but often, elderly patients have no obvious predisposing or precipitating factors(17).

2. Age
If you are over 50, you are at increased to develop colitis. According to the study of  the records of 81 patients with colitis whose symptoms began after the age of 50 years, ischemia is the most common cause of colitis beginning in patients older than 50 years of age. Moreover, the incorrect diagnosis of idiopathic inflammatory bowel disease in a large proportion of these patients may explain why colitis has been reported to behave differently in the elderly than in the young(18).

3. Depression and psychosocial stress
In the study to analyze the data from 152,461 women (aged 29-72 years) enrolled since 1992-1993 in the Nurses' Health Study cohorts I and II, conducted by Massachusetts General Hospital and Harvard Medical School, found that On the basis of data from the Nurses' Health Study, depressive symptoms increase the risk for CD, but not UC, among women. Psychological factors might therefore contribute to development of CD(19).

4. Gender and smoking
In the study of the medical charts of 1784 adult consecutive patients (978 patients, ulcerative colitis; 118 patients, indeterminate colitis; and 688 patients, Crohn's colitis), whose smoking habits were specified by direct interview, showed that The proportion of ever smokers was 42% in ulcerative colitis, 43% in indeterminate colitis, and 61% in Crohn's colitis. Smoking cessation preceded the onset of colitis in 279 patients with ulcerative colitis or indeterminate colitis (61%) and only 52 patients (12%) with Crohn's colitis. In ulcerative colitis and indeterminate colitis, current smoking delayed mean age at disease onset in men (from 32 to 41 yr; P < 0.001), but not women (from 33 to 33 yr), and decreased the need for immunosuppressants in men (10-yr cumulative risk, 26% +/- 4% in nonsmokers vs. 8% +/- 4% in smokers; P < 0.01), but not significantly in women. Conversely, in Crohn's colitis, current smoking hastened disease onset in women (from 35 to 29 yr; P < 0.001), but not men (from 32 to 31 yr), and increased the need for immunosuppressants in women (10-yr cumulative risk, 48% +/- 5% in nonsmokers vs. 58% +/- 4% in smokers; P < 0.01), but not men(20).

5. Family history
Approximately 5 to 10 percent of patients undergoing ileal pouch-anal anastomosis with a diagnosis of ulcerative colitis are subsequently diagnosed with Crohn's disease. Acoording to the study by Cedars-Sinai Medical Center, Los Angeles, patients with ulcerative colitis and indeterminate colitis with a family history of Crohn's disease or preoperative anti-Saccharomyces cerevisiae immunoglobulin-A seropositivity are more likely to be diagnosed with Crohn's disease after ileal pouch-anal anastomosis(21).

6. Other risk factors
According to the study by, in a multivariate model, familial history of inflammatory bowel disease (odds ratio (OR) 4.3 (95% confidence interval 2.3-8)), breast feeding (OR 2.1 (1.3-3.4)), bacille Calmette-Guerin vaccination (OR 3.6 (1.1-11.9)), and history of eczema (OR 2.1 (1-4.5)) were significant risk factors for Crohn's disease whereas regular drinking of tap water was a protective factor (OR 0.56 (0.3-1)). Familial history of inflammatory bowel disease (OR 12.5 (2.2-71.4)), disease during pregnancy (OR 8.9 (1.5-52)), and bedroom sharing (OR 7.1 (1.9-27.4)) were risk factors for ulcerative colitis whereas appendicectomy was a protective factor (OR 0.06 (0.01-0.36))(21a). Also in the study by University Hospital of Heraklion, found that the logistic regression analysis showed that appendectomy and tonsillectomy have no independent association with the risk of developing ulcerative colitis, whereas in Crohn's disease both appendectomy and tonsillectomy have positive associations. Well-established risk factors, such as family history and smoking status(21b). Appendicectomy is also an environmental factors that are known to influence ulcerative colitis (UC)(21c). 
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Sources
(16) http://www.ncbi.nlm.nih.gov/pubmed/23290973
(17) http://www.ncbi.nlm.nih.gov/pubmed/10223095
(18) http://www.ncbi.nlm.nih.gov/pubmed/7315820
(19)  http://www.ncbi.nlm.nih.gov/pubmed/22944733
(20) http://www.ncbi.nlm.nih.gov/pubmed/15017631
(21) http://www.ncbi.nlm.nih.gov/pubmed/18085333
(21a) http://www.ncbi.nlm.nih.gov/pubmed/15710983
(21b) http://www.ncbi.nlm.nih.gov/pubmed/10211500
(21c) http://www.ncbi.nlm.nih.gov/pubmed/15194646