Marked regional variations in the prevalence of inflammatory bowel disease in a limited geographical region are not associated with compounds in the drinking water

Regional differences in the incidence of lymphocytic and collagenous colitis over time

BACKGROUND

In microscopic colitis (MC), the incidence has increased over the last decades. The aim of the present study was to determine the incidence of lymphocytic (LC) and collagenous colitis (CC) in the county Skåne (Scania), southern Sweden, during the period 2010-20 with focus both on the temporal and spatial variations.

METHODS

The MC diagnosis was retrieved from the biopsy registries at the Departments of Pathology. Established diagnostic criteria (increased lymphocyte count, inflammation in lamina propria and in CC a collagen band) were used for diagnosis. Age, gender, date for diagnosis and municipality of residence were retrieved for all patients.

RESULTS

In total 1985 patients could be identified with a mean age of 62.9 years (SD 15.7) whereof 1415 were women. The incidence for CC was stable with a total age-standardized rate (ASR) per 100 000 person-years of 6.34, (range 4.6-8.1). In LC the ASR was 7.90 (range 1.7-15.2) but increased markedly 2015-20 reaching 15.2 in 2019. Also, the northwest part of the region showed significantly higher ASR:s of LC during the last part of the decade in comparation to the whole region.

CONCLUSIONS

The incidence of CC was stable during the period while LC differed substantially in a way that indicates that it most probably must be two different disease entities. In LC, in view of the marked and rapid increase, although no definitive explanation could be found, causative environmental factors could be contemplated, why further studies are indicated.

New insights into the role of metal(loid)s in the development of ulcerative colitis: a systematic review

The relationship between heavy metals and ulcerative colitis (UC) was investigated in several studies, but their results were not consistent. Therefore, in this systematic review study, the positive and negative effects of metal(loid)s (Zn, Cu, Fe, Se, Pb, Ni, and As) on UC disease were investigated. In this systematic search, 13 original articles from 1993 to 2021 were identified in Google Scholar, Science Direct, Scopus, PubMed, and the Web of Science databases. In included studies, the concentrations of heavy metals and essential elements were measured in the blood, serum, intestinal biopsies, and hair samples of the patients. Some studies have also examined the heavy metal concentration in UC patients' diet and their drinking water. In the serum samples, Pb (220 ± 108 mg/L) and Cu (401.5 ± 104 µg/L) had the maximum concentrations among the other elements, as well as Zn and Fe had the highest levels in hair and intestinal tissue samples, respectively. In light of the selected articles, there is a possibility of a preventive role for Se and Zn in UC development. Moreover, exposure to Fe can exacerbate the symptoms of the disease. In conclusion, this review reveals that toxic metals, as ubiquitous environmental pollutants, can contribute to the exacerbation of inflammatory intestinal symptoms, and consumption of essential elements can play a vital role in the control of UC, and it is important to pay attention to them in health decisions.

The Role of the Urban Exposome in the Increasing Global Rates of Pediatric Inflammatory Bowel Disease

Pediatric inflammatory bowel disease (IBD) is becoming increasingly common around the world, rapidly accelerating in regions undergoing rapid economic development. IBD is more common among those living in cities, and the association between the urban environment and IBD incidence is strongest in children. The "urban exposome" is defined as the totality of environmental exposures associated with urban living: air pollution, water contamination, green and blue space, nighttime light, noise, and availability of pre-processed and packaged foods. Investigation of the role of the urban exposome and IBD is in its infancy. Existing research has reached heterogeneous conclusions, and most studies have focused specifically on adult-onset disease and environmental exposures in isolation rather than the interaction between exposures. By better understanding the impact of the urban exposome on pediatric IBD, we can work to minimize these exposures and decrease the future burden of IBD in children.

A nationwide cohort study of the incidence of inflammatory bowel disease in Sweden from 1990 to 2014

BACKGROUND

Epidemiological studies have shown inconsistent incidence rates (IRs) for inflammatory bowel disease (IBD).

AIM

To assess the incidence and temporal trends of IBD in Sweden.

METHODS

Nationwide cohort study based on diagnostic codes for IBD and biopsy reports registered through the ESPRESSO cohort in 1990-2014. Age-specific and age-standardised IRs and cumulative incidence were calculated.

RESULTS

Overall, we identified 65 908 cases of incident IBD: ulcerative colitis (UC, n = 38 261, 58%), Crohn's disease (CD, n = 18 577, 28%) and IBD-U (n = 9070, 14%). During 1990-2014, the overall IRs per 100 000 person-years were 29.0 (95% CI: 27.3-30.7) for IBD, 16.9 (15.9-17.9) for UC, and 8.1 (7.7-8.6) for CD. For IBD-U, the IR was 5.2 (4.9-5.6) in 2002-2014. The annual incidence of IBD, UC and CD increased by approximately 7% per year between 1990 and 2001 (P < 0.001) and then decreased by 1%-2% per year from 2002 onwards (P < 0.001). IRs for IBD, UC and IBD-U were higher in males while the IR for CD was higher in females. The lifetime risk of IBD was about 2.5% for both sexes.

CONCLUSIONS

In Sweden, the incidence of IBD in all subtypes increased in 1990-2001 but has since declined. One in 40 individuals is expected to be diagnosed with IBD during their lifetime.

The Association between Drinking Water Quality and Inflammatory Bowel Disease-A Study in Eastern Croatia

The incidence rate of inflammatory bowel disease (IBD) is becoming a global health problem that could be caused by changes in environmental and lifestyle habits. The study aimed to identify the association between the quality of drinking water, i.e., physiochemical and biological aspects of the phenotype and activity of IBD in Eastern Croatia. The study included 312 patients (63.4% ulcerative colitis, UC, and 36.6% Crohn's disease, CD) from the area of Eastern Croatia. The data were collected by questionnaires and the analysis of the water safety, based on 65 samples of drinking water by the patient's water supply method (public supply, rural water supply, and private well). IBD was active in 38.0% patients (34.0% CD and 40.0% UC). Significant differences (p = 0.001) were observed in the distribution of patients, according to counties in which they lived in. The largest deviation was noted in coliform bacteria, Escherichia coli, and enterococci bacteria, Fe, Al, and nitrate in rural water supply and private wells, although, without significant impact on IBD phenotype and activity. The hazard quotient (HQ) simulations showed that children are a sensitive group, regarding exposure to nitrates in drinking water over a long period of time, so there is a need for further monitoring and analysis of this issue.