Younger immigrants at higher risk of developing inflammatory bowel disease
The younger a person is when they immigrate to Canada, the higher their risk of developing inflammatory bowel disease (IBD), and its major subtypes Crohn’s disease and ulcerative colitis, according to a study by researchers at the University of Ottawa, the Institute for Clinical Evaluative Sciences (ICES) and the Children’s Hospital of Eastern Ontario (CHEO). Canada has one of the highest rates in the world of IBD and while immigrants to Canada have lower rates of IBD compared to Canadian-born residents, that risk goes up in immigrants who are younger at arrival to Canada. In addition, Canadian-born children of immigrants from some regions have a higher risk of developing IBD.
While their parents were at lower risk of developing IBD, once they arrive the children of immigrants from the Middle East, North Africa and South Asia had the same incidence of IBD compared with the children of non-immigrants. In fact, there is a 14 per cent increased risk per younger decade of life at immigration. However, the children of immigrants from East Asia, Eastern Europe, Central Asia, Latin America and the Caribbean had lower incidence of IBD compared with the children of non-immigrants.
“These findings suggest an increased risk of IBD when there is early-life exposure to the Canadian environment in immigrants from some regions,” said Dr. Eric Benchimol, adjunct scientist with ICES, and pediatric gastroenterologist at CHEO.
The study, published today in American Journal of Gastroenterology, is the first population-based study to demonstrate the increased risk in the children of immigrants to Canada. This indicates that the environment plays an important role in IBD pathogenesis.
“IBD is a disease of Westernized nations, with high rates in North America and Europe, and low rates in Asia, Africa, and South America. Rates increased dramatically in Eastern Europe in recent decades and are increasing in other nations as Western lifestyle becomes more prevalent,” added Benchimol.
Canada has some of the highest rates of IBD (Crohn’s disease and ulcerative colitis) in the world with 240,000 Canadians affected. Ontario has a very high rate of IBD (1/160 people), and the fastest growing group of new diagnoses is children under 10-years-old. The recent rapid increase in IBD suggests environmental risk factors.
What is inflammatory bowel disease (IBD)?
Inflammatory bowel disease (IBD) is the name of a group of disorders that cause the intestines to become inflamed (red and swollen). The inflammation lasts a long time and usually comes back over and over again. Approximately 1.4 million Americans have some kind of inflammatory bowel disease.
The two primary types of inflammatory bowel disease are Crohn’s disease and ulcerative colitis.
What is Crohn’s disease?
Crohn’s disease is an IBD that causes ulcers to form in the gastrointestinal (GI) tract anywhere from the mouth to the anus. Crohn’s disease can have “skip” areas that are normal, in between areas that are affected. Some people who have Crohn’s disease have severe symptoms, while others have less severe symptoms. Some people who have the disease have long periods without symptoms, even without getting treatment. Others with more severe disease will need long-term treatment or even surgery.
What is ulcerative colitis?
Ulcerative colitis (say: “ul-sir-uh-tiv cole-eye-tiss”) is an IBD that causes your colon (large intestine) to become red and swollen. The redness and swelling can last for a few weeks or for several months. Ulcerative colitis always involves the last part of the colon (the rectum) and can go higher up in the colon, up to involving the whole colon, but never has the “skip” areas typical of Crohn’s disease. Symptoms may come and go for up to a year. These occurrences are called flare-ups.
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Authors: Eric I Benchimol, David R Mack, Astrid Guttmann, Geoffrey C Nguyen, Teresa To, Nassim Mojaverian, Pauline Quach and Douglas G Manuel.
“Inflammatory bowel disease in immigrants to Canada and their children: a population-based cohort study,” was published in American Journal of Gastroenterology.
ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.
For the latest ICES news, follow us on Twitter: @ICESOntario
The CHEO Research Institute coordinates the research activities of the Children’s Hospital of Eastern Ontario (CHEO) and is affiliated with the University of Ottawa. Its three programs of research include molecular biomedicine, health information technology, and evidence to practice research; key research themes include cancer, diabetes, obesity, mental health, emergency medicine, musculoskeletal health, electronic health information and privacy, and genetics of rare disease. The CHEO Research Institute makes discoveries today for healthier kids tomorrow.
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Adrienne Vienneau
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Children’s Hospital of Eastern Ontario Research Institute
Journal
American Journal of Gastroenterology