Issue 17

Clinical Question

Do early-life and neonatal factors increase the risk of IBD?

Editor’s Bottom Line

Early life events that predict future risk of IBD might act through changes in the microbiome. More data are needed to distinguish the effects of antibiotic treatment from those of the underlying infection.

Reference

Bernstein CN, Burchill C, Targownik LE, et al. Events Within the First Year of Life, but Not the Neonatal Period, Affect Risk for Later Development of Inflammatory Bowel Diseases. Gastroenterol. 2019;156:2190–97; https://doi.org/10.1053/j.gastro.2019.02.004

Synopsis

Researchers at the University of Manitoba examined medical records from 825 patients with IBD diagnosed between 1984 and 2010 and registered in the province’s IBD Epidemiology Database. Data were collected from neonatal and post-natal periods as well as maternal and sibling health records. Variables including demographic traits, clinical events, failure to thrive, hospitalization in the first year of `life and, for some patients, gestational age, Apgar score, neonatal intensive care unit admissions, and birth weight. IBD cases were compared with 5,999 matched controls as well as IBD patients’ siblings. IBD patients were a median 17 years of age at the time of analysis.

The strongest risk factor for an IBD diagnosis was a maternal IBD diagnosis, which increased the risk of IBD at any age nearly five-fold, compared to controls (Odds Ratio [OR]: 4.53; 95% Confidence Interval [CI], 3.08–6.67; P<0.001). Other significant predictors of IBD at any age were high socioeconomic classification during the neonatal period (OR for 5^th quintile vs. 1^st quintile: 1.35; 95% CI, 1.01–1.79; P=0.04), infection in the first year of life, which increased the risk of IBD diagnosis at any age (OR: 1.39; 95% CI, 1.09–1.79; P=0.01) and more strongly before the ages of 10 (OR: 3.06; 95% CI, 1.07–8.78; P=0.04) and 20 years (OR: 1.63; 95% CI, 1.18–2.24; P=0.003). Hospitalization for gastrointestinal-specific infections, gastrointestinal disease, or abdominal pain in the first year of life did not increase the risk of IBD, while birth in a rural setting reduced the risk of an IBD diagnosis (OR: 0.84; 95% CI, 0.72–0.99; P=0.04).

The authors proposed that antibiotic use might explain the association between early infection and subsequent IBD diagnosis.

Details

Study Design: Epidemiologic
Funding: The University of Manitoba
Allocation: Not applicable
Setting: Population database
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.