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Digestive Diseases and Sciences

, Volume 39, Issue 3, pp 555–560 | Cite as

Childhood infections and the risk of inflammatory bowel disease

  • John I. Wurzelmann
  • Cynthia M. Lyles
  • Robert S. Sandler
Original Articles

Abstract

Adults with inflammatory bowel disease from North Carolina were questioned during 1986 and 1987 to assess risk due to a variety of childhood infections and treatments with antibiotics. Responses were compared with those of neighbor controls. Persons with Crohn's disease were more likely to report an increased frequency of childhood infections in general (odds ratio 4.67, 95% CI 2.65–8.23) and pharyngitis specifically (odds ratio 2.14, 95% CI 1.30–3.51). This was validated by an increased frequency of tonsillectomy (odds ratio 1.53, 95% CI 1.07–2.20). Crohn's cases were more likely to report frequent treatment with antibiotics for both otitis (odds ratio 2.07, 95% CI 1.03–4.14) and pharyngitis (odds ratio 2.14, 95% CI 1.20–3.84). Although Crohn's cases were more likely to report frequent exposure to penicillin (odds ratio 1.81, 95% CI 0.98–3.31), there did not appear to be excess risk conferred by penicillin after controlling for frequency of infections. Persons with ulcerative colitis also reported an excess of infections generally (odds ratio 2.37, 95% CI 1.19–4.71), but not an excess of specific infections or treatments with antibiotics. Persons who reported an increased frequency of infections tended to have an earlier onset of Crohn's disease (P<0.0001) and ulcerative colitis (P=0.04). Finally, it was noted that urban living in childhood increased the risk for Crohn's disease. We conclude that childhood infections may be a risk factor for Crohn's disease and may presage the early onset of disease.

Key words

Crohn's disease epidemiology inflammatory bowel disease ulcerative colitis antibiotics penicillin 

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References

  1. 1.
    Mendeloff AI, Calkins BM: The epidemiology of idiopathic inflammatory bowel disease.In JB Kirsner, RG Shorter (eds). Inflammatory Bowel Disease. Philadelphia, Lea and Feibiger, 1988, pp 3–34Google Scholar
  2. 2.
    Tysk C, Lindberg E, Jarnerot G, Floerus-Myrhed B: Ulcerative colitis and Crohn's disease in an unselected population of monozygotic and dizygotic twins. A study of heritability and the influence of smoking. Gut 29:990–999, 1988PubMedGoogle Scholar
  3. 3.
    Sonnenberg A, McCarty DJ, Jacobsen SJ: Geographic variation of inflammatory bowel disease within the United States. Gastroenterology 100:143–149, 1991PubMedGoogle Scholar
  4. 4.
    Ekbom A, Helmick C, Zack M, Adami H-O: The epidemiology of inflammatory bowel disease: A large population-based study in Sweden. Gastroenterology 100:350–358, 1991PubMedGoogle Scholar
  5. 5.
    Gollop JH, Phillips SF, Melton LJ III, Zinmeister AR: Epidemiologic aspects of Crohn's disease: A population based study in Olmsted County, Minnesota, 1943–1982. Gut 29:49–56, 1988PubMedGoogle Scholar
  6. 6.
    Humphreys WG, Parks TG: Crohn's disease in Northern Ireland—a retrospective study of 159 cases. Ir J Med Sci 144:437–446, 1975PubMedGoogle Scholar
  7. 7.
    Kyle J: An epidemiologic study of Crohn's disease in northeast Scotland. Gastroenterology 61:826–833, 1971PubMedGoogle Scholar
  8. 8.
    Sinclair TS, Brunt PW, Mowat NAG: Nonspecific proctocolitis in northeastern Scotland: A community study. Gastroenterology 85:1–11, 1983PubMedGoogle Scholar
  9. 9.
    Aabakken L, Osnes M: Non-steroidal anti-inflammatory drug-induced disease in the distal ileum and large bowel. Scand J Gastroenterol Suppl 163:48–55, 1989PubMedGoogle Scholar
  10. 10.
    Acheson ED, Truelove SC: Early weaning in the aetiology of ulcerative colitis. Br Med J 2:929–933, 1961Google Scholar
  11. 11.
    Bergstrand O, Hellers G: Breast-feeding during infancy in patients who later develop Crohn's disease. Scand J Gastroenterol 18:903–906, 1983PubMedGoogle Scholar
  12. 12.
    Koletzko S, Sherman P, Corey M, Griffiths A, Smith C: Role of infant feeding practices in the development of Crohn's disease. Br Med J 298:1617–1618, 1989Google Scholar
  13. 13.
    Whorwell PJ, Holdstock G, Whorwell GM, Wright R: Bottle feeding, early gastroenteritis and inflammatory bowel disease. Br Med J 1:382, 1979PubMedGoogle Scholar
  14. 14.
    Breslow NE, Day NE: Statistical Methods in Cancer Research. Vol 1. The Analysis of Case-Control studies. Lyon, International Agency for Research on Cancer, 1980Google Scholar
  15. 15.
    Mantel N, Haenszel W: Statistical aspects of data from retrospective studies of disease. J Natl Cancer Inst 22:719–748, 1959PubMedGoogle Scholar
  16. 16.
    Mantel N: Chi-square test with one degree of freedom: Extensions of the Mantel-Haenszel procedure. J Am Stat Assoc 58:690–700, 1963Google Scholar
  17. 17.
    Gilat T, Hacohen D, Lilos P, Langman MJS: Childhood factors in ulcerative and Crohn's disease. An international cooperative study. Scand J Gastroenterol 22:1009–1024, 1987PubMedGoogle Scholar
  18. 18.
    Ekbom A, Adami HO, Helmick CG, Jonzon A, Zack MM: Perinatal risk factors for inflammatory bowel disease: A case-control study. Am J Epidemiol 132:1111–1119, 1990PubMedGoogle Scholar
  19. 19.
    Koletzko S, Griffiths, Corey M, Smith C, Sherman P: Infant feeding practices and ulcerative colitis in childhood. Br Med J 302:1580–1581, 1991Google Scholar
  20. 20.
    Sartor RB, Cromartie WJ, Powell DW, Schwab KH: Granulomatous enterocolitis induced in rats by purified bacterial cell wall fragments. Gastroenterology 89:587–595, 1985PubMedGoogle Scholar
  21. 21.
    Park H, Zeiger AR, Schumacher HR: Detection of soluble peptidoglycan in urine after penicillin administration. Infect Immun 43:139–142, 1984PubMedGoogle Scholar
  22. 22.
    Kirschner BS, Newcomb SA: Increased prevalence of rheumatic fever in the relatives of pediatric patients with chronic inflammatory bowel disease. Gastroenterology 86:1135, 1984Google Scholar

Copyright information

© Plenum Publishing Corporation 1994

Authors and Affiliations

  • John I. Wurzelmann
    • 1
  • Cynthia M. Lyles
    • 1
  • Robert S. Sandler
    • 1
  1. 1.From the Division of Digestive Disease and Nutrition, Center for Gastrointestinal Biology and Disease, General Clinical Research CenterUniversity of North CarolinaChapel Hill

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