Environmental factors affecting the development of IBD
- Smoking
Cigarette smoking plays an integral role in the development of CD. Although cigerette smoking does play an important role in the development of UC, it is important to note that people who frequently develop UC are non smokers.Smoking affects both systemic and mucosal immunity, altering a wide range , altering a wide range of both innate and adaptive immune functions. Smoking Alters the ratio of T-helper to T-Suppressor cells, reduces T cell proliferation, modulates apoptosis and significantly decreases serum and mucosal immunoglobulin levels. Furthermore, smoking enhances small bowel permeability and colonic mucus production.
- Diet
Diet and food allergens have been linked to the etiology of both UC and CD. Foods and substances food to have the most profound effect on the development of IBD include: Alcohol, sugar and artificial sweeteners and foods containing high amounts of fatty acids.
- Drugs
Drugs such as oral contraceptives and NSAIDs have been hypothesized to correlates with the development of both UC and CD. Although proof that oral contraceptive, may cause IBD is ambiguous,studies have found that NSAIDs accelerate an in some cases worsen the colonic inflammation associated with blockade of protective prostaglandins and altered mucosal immune activity.
- Geographical Location, Social Economic status, education and occupational status
Traditionally, IDB has been intimately linked with Western and European societies. IDB more commonly affects white and blue collar workers. IDB is more common in indoor workers than it is in outdoor occupational workers. This can be attributed to the fact that individuals who work indoors tend to be more sedentary. This lack of activity in turn prolongs the time during which food antigens are in contact with the gut wall resulting in inappropriate stimulation and an inflammatory reaction.
- Stress
Although stress has not been identified as a primary cause of IDB in and of itself, it has been known to modulate the course of IDB. The exact mechanism underlying stress-induced exacerbation of IDB is unknown.
- Microbial factors
Several microoganisms such as; Listeria monocytogenes, Chlamydia tracomatis, Escherichia coli, Cytomegalovirus, Saccharomyces cerevisiae have been proposed to play an etiological role in the development of IDB. A viral etiology of IBD has also been identified within the recent years. Viral agents play a greater contribution in the development of Crohns Disease than Ulcerative Colitis. The finding of paramixovirus-like particles in Crohn's Disease endothelial granulomas suggests that Crohns Disease may be caused by the persistence of the Measles virus in the endothelial mucosa.
- Intestinalpermeability
Although not an environmental factor per se intestinal permeability has been postulated as an early predisposing factor to the pathogenesis of Crohn's Disease. Increased permeability as a result of increased entry of antigenic material has a known impact on the mucosal immune response to dietary and enteric bacterial antigens.
(Danese, Sans and Fiocchi, 2004)
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