Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Infections Within First Year of Life Can Predict IBD

Key clinical point: Infections during the first year of life are associated with a subsequent diagnosis of inflammatory bowel disease.

Major finding: The correlation was strongest for onset by age 10 years (3.1; 95% confidence interval, 1.1-8.8).

Study details: A population-based study of 825 patients with inflammatory bowel disease and 5,999 matched controls.

Disclosures: The Manitoba Centre for Health Policy provided access to the Population Health Research Data Repository. Dr. Bernstein is supported by the Bingham Chair in Gastroenterology. He reported ties to AbbVie Canada, Ferring Canada, Janssen Canada, Shire Canada, Takeda Canada, Pfizer Canada, Napo Pharmaceuticals, 4D Pharma, and Mylan.

Citation:

Bernstein CN et al. Gastroenterology. 2019 Feb 14. doi: 10.1053/j.gastro.2019.02.004.

Commentary:

Understanding and exploring factors that could impact inflammatory bowel disease (IBD) development is imperative. This study by Bernstein et al. evaluated whether environmental factors in the first year of life may impact subsequent diagnosis of IBD using population-based cohort data with robust and detailed health information. Maternal history of IBD was the most predictive factor in development of IBD, further evidence of a genetic component to disease pathogenesis. However, environmental factors such as high socioeconomic status within the first year of life were predictive of diagnosis of IBD later in life, possibly lending further support to the “hygiene hypothesis.” Also, significant infections identified in the clinical setting or requiring hospitalization were predictive of subsequent IBD diagnosis. This is particularly interesting as gut microbiome perturbations increasingly take the stage as a possible pathway of significance in IBD. Could infection within the first year of life or the subsequent antibiotic use required affect the gut microbiome so significantly and perhaps permanently to affect development of later childhood or adult IBD?

While these are associations at a population-based level and not clear-cut causation, much can be considered for future research directions. Identifying high-risk patients extremely early in life may be key to further understand the complex interplay of genetic susceptibility and environmental influence. Whether any of these factors are modifiable will be a question that will only continue to gain importance as global rates of IBD continue to increase.

Sara Horst, MD, MPH, is an associate professor of medicine in the department of gastroenterology, hepatology, and medicine at Vanderbilt University, Nashville, Tenn. She has consulted for Janssen, UCB, and Boehringer Ingelheim.