Journal
GUT
Volume 62, Issue 4, Pages 630-649Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/gutjnl-2012-303661
Keywords
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Categories
Funding
- Ferring
- Janssen Hong Kong
- Bingham chair in gastroenterology
- Abbott Canada
- Axcan Pharma
- Aptalis
- Abbott
- MSD Hungary
- Abbott Labs
- UCB
- Janssen Biotech
- Shire
- Bristol-Myers Squibb
- GlaxoSmithKline
- Amgen
- Pfizer
- Braintree
- Millenium-Takeda
- MSD
- Centocor
- Abbott Laboratories
- Biogen Idec Inc
- Boehringer-Ingelheim
- Bristol Meyers Squibb
- Cellerix SL
- Chemocentryx, Inc
- Cosmo Technologies, Ltd
- Elan Pharmaceuticals, Inc
- Genentech
- Giuliani Spa
- Given Imaging
- Glaxo Smith Kline
- Immune Pharmaceuticals Ltd
- Merck Co, Inc
- Millenium Pharmaceuticals Inc
- Neovacs SA
- Ocerra Therapeutics, Inc
- Pfizer Inc
- Prometheus
- Sanofi
- Schering Plough Corp
- Shire Pharmaceuticals
- Synta Pharmaceutical Corp
- Takeda
- Teva Pharmaceuticals
- Petah Tikva
- Therakos
- TXcell
- UCB Pharma
- Wyeth Pharmaceuticals
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The changing epidemiology of inflammatory bowel disease (IBD) across time and geography suggests that environmental factors play a major role in modifying disease expression. Disease emergence in developing nations suggests that epidemiological evolution is related to westernisation of lifestyle and industrialisation. The strongest environmental associations identified are cigarette smoking and appendectomy, although neither alone explains the variation in incidence of IBD worldwide. Urbanisation of societies, associated with changes in diet, antibiotic use, hygiene status, microbial exposures and pollution have been implicated as potential environmental risk factors for IBD. Changes in socioeconomic status might occur differently in different geographical areas and populations and, consequently, it is important to consider the heterogeneity of risk factors applicable to the individual patient. Environmental risk factors of individual, familial, community-based, country-based and regionally based origin may all contribute to the pathogenesis of IBD. The geographical variation of IBD provides clues for researchers to investigate possible environmental aetiological factors. The present review aims to provide an update of the literature exploring geographical variability in IBD and to explore the environmental risk factors that may account for this variability.
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