Indian Journal of Gastroenterology

, Volume 30, Issue 6, pp 264–269 | Cite as

Environmental factors associated with Crohn’s disease in India

  • Srinivasan Pugazhendhi
  • Manoj Kumar Sahu
  • Venkataraman Subramanian
  • Anna Pulimood
  • Balakrishnan S. RamakrishnaEmail author
Original Article



The frequency of diagnosis of Crohn’s disease (CD) in India is increasing. This case-control study was designed to detect associations of environmental and dietary factors with the diagnosis of CD.


In 200 consecutive patients with CD and 200 control subjects without gastrointestinal disease, environmental hygiene exposures in childhood and in the past one year, and dietary preferences were recorded using a questionnaire. Univariate and multivariate analyses were done.


In univariate analysis, CD showed positive association with urban residence (at birth and current), availability of protected drinking water (childhood and current), availability of piped water in the house (childhood and current), and strict vegetarian dietary habit, and negative association with regular fish consumption and presence of cattle in the house compound. Multivariate analysis showed that regular fish consumption (OR 0.52, 95% CI 0.33–0.80, p = 0.003), and presence of cattle in the house compound currently (OR 0.57, 95% CI 0.35–0.92, p = 0.023) were significant protective associations, whereas use of safe drinking water was positively associated (OR 1.59, 95% CI 1.02–2.47, p = 0.042) with the disease.


Occurrence of CD was associated with dietary and environmental exposures, which indicate that diet and hygiene may influence the development of this disease.


Case-control study Hygiene Inflammatory bowel disease 



This study was supported by a grant-in-aid from the Washington University School of Medicine, St. Louis, USA. The authors wish to thank Dr. Joshua Korzenik (Massachussetts General Hospital, Boston, MA, USA) who was responsible for generating this grant and for supporting this activity.

Author contributions

SP contributed to supervision and data analysis; MKS contributed to data collation and analysis; VS to design of study and data collection; AP to histological diagnosis, and BSR to design, overall supervision, data analysis, and writing up the paper.


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Copyright information

© Indian Society of Gastroenterology 2011

Authors and Affiliations

  • Srinivasan Pugazhendhi
    • 1
  • Manoj Kumar Sahu
    • 1
  • Venkataraman Subramanian
    • 2
  • Anna Pulimood
    • 1
  • Balakrishnan S. Ramakrishna
    • 1
    Email author
  1. 1.Department of Gastrointestinal SciencesChristian Medical CollegeVelloreIndia
  2. 2.Wolfson Institute of Digestive DiseasesNottinghamUK

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