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Environmental Factors in the Relapse and Recurrence of Inflammatory Bowel Disease: A Review of the Literature

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Abstract

Introduction

The causes of relapse in patients with Crohn’s disease (CD) and ulcerative colitis (UC) are largely unknown. This paper reviews the epidemiological and clinical data on how medications (non-steroidal anti-inflammatory drugs, estrogens and antibiotics), lifestyle factors (smoking, psychological stress, diet and air pollution) may precipitate clinical relapses and recurrence. Potential biological mechanisms include: increasing thrombotic tendency, imbalances in prostaglandin synthesis, alterations in the composition of gut microbiota, and mucosal damage causing increased permeability.

Results

The clinical epidemiological data consistently reports positive associations between smoking and relapses in CD, and inverse ones with UC. For NSAIDs and estrogens, the epidemiological findings are inconsistent, although general antibiotic use was associated with a reduced risk of relapse in CD. High levels of stress were positively associated with relapse, although psychological interventions did not have therapeutic benefits. The limited work on diet has reported sulphur-containing foods are positively associated with relapse in UC, but there is no work in CD. Ecological data reported positive correlations between air pollution levels and IBD hospitalisations.

Conclusions

In the future, to clarify this area, more clinical epidemiological work is required where detailed drug types and doses, and complete dietary intakes are measured, in specific forms of IBD. Such work could provide guidance to both patients and doctors to help maintain remission.

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Acknowledgments

The Jean Shanks foundation for their scholarship award and the Norfolk and Norwich University Hospital gastroenterology research fund for their financial support of Thomas D Martin. SSMC is supported by an NIHR clinical lectureship.

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  1. Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK

    Thomas D. Martin, Simon S. M. Chan & Andrew R. Hart

  2. Department of Gastroenterology, Norfolk and Norwich University Hospital, NHS Trust, Colney Lane, Norwich, NR4 7UY, UK

    Simon S. M. Chan & Andrew R. Hart

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  1. Thomas D. Martin
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Martin, T.D., Chan, S.S.M. & Hart, A.R. Environmental Factors in the Relapse and Recurrence of Inflammatory Bowel Disease: A Review of the Literature. Dig Dis Sci 60, 1396–1405 (2015). https://doi.org/10.1007/s10620-014-3437-3

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