How Do You Know If You Are At Risk of Developing Inflammatory Bowel Disease?

The term Inflammatory Bowel Disease refers to the two relatively common bowel diseases , Ulcerative Colitis and Crohn’s Disease.

Although they are different in many aspects, including symptoms, behavior, management and prognosis (long term outcome), they are still considered a spectrum of an inflammatory process involving the gut that may be, in some patients, difficult to tell for sure whether it's Ulcerative Colitis or Crohn's disease.

What do we mean by risk factors?

For a particular disease, there may be a factor or multiple factors (genetic or environmental), when present, a subject will be at a higher risk of developing that disease in the future, compared with normal population.

Some risk factors are modifiable, i.e. we can eliminate them to minimize the risk of acquiring the disease, while other factors are non-modifiable, hence the risk can't be removed or changed by any means.

How common is Inflammatory Bowel Disease?

Every year, 2 to 20 persons out of 100,000 , are diagnosed with inflammatory bowel disease, either ulcerative colitis or Crohn’s disease, in North America.

The estimated number of patients with inflammatory bowel disease in the United States is around 200 per 100,000 population.

Inflammatory bowel disease is less common in the Far and Middle East, though its incidence is increasing.

What causes Inflammatory Bowel Disease?

The exact cause of inflammatory bowel disease is not clear. Although we know that certain environmental and genetic factors play significant role in the causation of the disease, but it's not yet known why only some persons develop the disease and others don't.

Are you at risk?

Studies have shown that the risk of having inflammatory bowel disease is high when some factors exist. The risk becomes further higher if multiple factors interplay.

How old are you?

If you are young (15-40 years) , you are in the age group at which, most of the new cases are diagnosed.

Below the age of 15 and above the age of 40, inflammatory bowel disease occurs less frequently.

If you are older than 40, your risk will remain lower until you are the age of 50, when the risk raises again steadily to reach a peak at the age of 60-65 years.

What's your race and ethnic origin?

The disease is more common in Jews, and less common in blacks and Hispanics.

Your risk related to ethnic origin may be altered if you migrate to a geographical area with different (higher or lower) incidence of inflammatory bowel disease. If you are from an ethnic group with low risk of inflammatory bowel disease, and you move to an area where the disease incidence is high, you will acquire the same risk level of that area over years.

This is clearly indicative of the strong influence of the environment on triggering the disease onset, independently from other factors.

Do you have a close relative with inflammatory bowel disease?

If you have a family member with inflammatory bowel disease you are genetically susceptible, and you are certainly at higher risk to have the disease in the future.

Up to 25 percent of inflammatory bowel disease patients have family members with either ulcerative colitis or Crohn’s disease.

Do you smoke?

Smoking elevates the risk of Crohn’s disease. In patients who already have Crohn’s disease, smoking cessation can significantly decrease disease severity, frequency of flares, and improves response to treatment.

On the other hand, smoking doesn't increase the risk of ulcerative colitis, and may even protect from ulcerative colitis (don't take this as an advice to smoke!).

Interestingly, patients with ulcerative colitis, who give up smoking, suffer from worsening of their disease.

What about your dietary habits?

If you consume high sugar, processed or fried food (i.e. Western diet), you are putting yourself at risk of getting Crohn's disease.

Similarly, if you eat excess fat (especially animal fat), your risk will be further augmented.

In contrast, if you follow a healthy dietary style, with high fiber content, you are less likely to catch inflammatory bowel disease.

Did you suffer from allergy to cow’s milk protein when you were infant?

If yes, your risk of having ulcerative colitis will be higher than those who had no such allergy.

Are you obese?

If the answer is yes, then you are certainly at risk. Obese people, in addition to their higher possibility to get the disease, the already affected obese persons, are more likely to have a worse disease course.

Have you had gastroenteritis?

If you had been diagnosed with gastroenteritis, particularly caused by Salmonella or Campylobacter species of bacteria , you are at higher risk of acquiring inflammatory bowel disease, even 15 years after the episode of gastroenteritis.

Do you use pain killers (analgesics)?

If , for any medical problem (e.g joint disease) , you take the type of analgesics known as Non-Steroidal Anti-inflammatory Drugs (NSAIDs), you may be put at small risk. It has to be a chronic use, for at least 15 days a month, for the risk to be significant.

The use of Acetaminophen (Paracetamol) doesn't appear to affect the risk of inflammatory bowel disease.

Do you use oral contraceptive pills and hormone replacement therapy?  

Both oral contraceptives, and hormone replacement therapy (for post menopausal women) may increase the risk of inflammatory bowel disease.

Have you had Appendectomy?  

For unclear reasons, the surgical removal of the appendix (appendectomy), may protect you from having ulcerative colitis. This is particularly significant , if your surgery was before the age of 20, and if the appendix was obviously inflamed (since it can be normal during surgical excision when the diagnosis is incorrect).

In conclusion:

Having an elevated risk to develop a disease doesn't mean that you will inevitably develop it.

It means that you should intervene to modify risk factors that can be modified in order to lower the risk as much as you can.

For the above mentioned risk factors, some are modifiable and some are not.

It's very obvious that risk factors which can be modified or eliminated would positively influence your health in general and not just protect you from developing inflammatory bowel disease, if you modify or eliminate them.

To minimize your risk, you should:

  • Avoid smoking
  • Lose excess body weight
  • Eat healthy diet: high fiber, and low fat. Avoid processed and high sugar food.
  • Avoid unnecessary use of analgesics
  • For birth control, use safer methods instead of oral pills.
  • For postmenopausal symptoms, discuss with you doctor the use of less risky medications than hormonal treatment.

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