Environmental Risk Factors for Relapses in Pediatric Onset Inflammatory Bowel Disease

Abstract Background Inflammatory bowel disease (IBD) in pediatric age group is influenced by the complex interactions of genes, the immune system, intestinal microbiota, and the external environment. There is currently little knowledge on environmental factors associated with its relapse. Objective The aim of this study is to assess the environmental risk factors of relapse of IBD in pediatric patients. Methods Patients diagnosed with pediatric IBD at one tertiary centre were included in a cross-sectional study. Clinical and endoscopic data together with medications were reported and laboratory investigations including stool analysis and culture and sensitivity were done. Food frequency questionnaires were obtained initially at remission and at relapse time. Results Fifty IBD patients were included; 30 males and 20 females with mean age of 12.91± 2.68 years. Of these, 28 patients (56%) had Ulcerative colitis (UC) and 22 patients (44%) had Crohn’s disease (CD). Most of them came from Urban (76%) and (24%) from rural areas. None has family history of similar cases of IBD. About one third of them (36%) has history of previous hospital admissions, surgeries or blood transfusion and 46% were exposed to smoking. All subjects were fully vaccinated according to national program of immunization. Unexpectedly, stool culture & sensitivity for the common incriminated organisms in relapse showed positive results in only 16% of cases (14 %and 2%) for E-coli and salmonella respectively. The application of food frequency questionnaire revealed that disease activity index during relapses was significantly correlated to higher lipids and lower fibers dietary consumption (P-value 0.000 and 0.005) respectively. Conclusion Achieving disease remission is one of the main objectives in treating IBD patients. Enteric infections and certain dietary habits are important environmental risk factors for IBD relapse. Patients presenting with relapse of IBD should have stool examined microbiologically and are candidates for dietary modification. This might lead not only to relief of symptoms but also a better quality of life.