Cases of Crohn's Rising in Scotland, Canada (Ontario), and Northern France

I read three posts in the About.com IBD blog about recent epidemiology studies pointing to rising cases of Crohn's in Scotland and Ontario, Canada. Also came across a study that showed rising cases in youth (0 - 19 yrs) in Northern France.

Here's the post about Scotland:

Scotland Has High Incidence of Pediatric IBD

Monday July 13, 2009

Researchers in Scotland are puzzled by the dramatic increase of pediatric cases of inflammatory bowel disease (IBD) in recent years. IBD is increasing all over Europe, but the 4-fold increase in Crohn's disease in Scotland has been the most dramatic. Scottish researchers are currently recruiting for a new study to determine what may be causing the rise in IBD cases. The research will focus on the role bacteria may play in the onset of IBD. The BISCUIT (Bacteria in Inflammatory bowel disease in Scottish Children Undergoing Investigation before Treatment) Study is underway at the Royal Aberdeen Children's Hospital, with plans to expand to hospitals in Dundee, Edinburgh, and Glasgow.

And here's the post about Ontario:

Increased Rate of IBD in Ontario Children

Monday August 10, 2009

A new population-based study has shown that the rate of inflammatory bowel disease (IBD) in children in Ontario, Canada is increasing. The rate of IBD in children under the age of 18 increased from 42.1 per 100,000 in 1994 to 56.3 per 100,000 in 2005. The most striking increases occurred in preschool and school-aged children. The rates in pre-teens and teenagers showed no significant change. The authors stress that even at the increased rate, IBD is still considered rare in children.

It's already known that Canada has a very high rate of IBD, and especially pediatric IBD. The authors of this study indicate that the high immigration rates from south Asia to Ontario may be partly responsible. Research has shown that Asian immigrants to Ontario have a higher risk of developing IBD. The theory is that being exposed to the Western environment increases the likelihood of developing IBD.

And a much earlier post about Canada in general:

O Canada! Why So Much IBD?

Monday November 20, 2006

Inflammatory bowel disease (IBD) is known to be a “western” disease. In other words, it largely affects people who live in western societies. Canada appears to be a hotbed for IBD. Crohn’s disease appears to be particularly prevalent, with 13.4 per 100,000 people in Canada having the disease. In the United States, about 10 people per 100,000 have IBD. An estimated 0.5% of all Canadians have one of the two major forms of IBD. What can explain this?

The theory is that it’s the cold. The cold temperatures create a “sterile” environment which is inhospitable to bacteria. It is thought that when children are raised in an environment where they are exposed to too few bacteria, the risk of IBD is higher. Low exposure to bacteria can also occur in “too hygienic” conditions as well as cold climates.

The authors of the study published in American Journal of Gastroenterology that reported these findings indicate that hygiene and other factors may influence the development of IBD. They stress, however, that the exact cause(s) of IBD are not yet clear.

I thought the second (highlighted) paragraph in the last post was interesting. I have read elsewhere that rates of IBD are higher in northeastern areas. That's an interesting explanation for why it might be the case. Also, it could also be interesting to test dairy products in those regions to see if there is an increased presence of MAP.

Here's the text of the final study about children in Northern France:

The Changing Pattern of Crohn’s Disease Incidence According to Age in Northern France: A Constant Increase in the 0-19 Years Age Group (Abstract #114)

A population-based study of residents in northern France finds that the incidence of Crohn’s disease (CD) is on the rise, most dramatically among young people less than 19 years of age. The findings raise a number of questions about the likely causes of the increase, which the investigators say could be related to environmental factors.

Investigators from the EPIMAD registry in France tracked rates of CD among nearly six million patients in northern France between 1988 and 2005. They found that the incidence of CD among all patients increased 20.7 percent but that rates had stabilized 10 years into the study. Among young people less than 19 years of age however, the incidence of CD increased linearly by 48.5 percent.

The cause of the increased incidence of CD among young people is unknown, but investigators say aggravating factors like environmental pollution and changes in diet or smoking habits could be culprits.

“Since we now know that CD disproportionately affects young people, future studies to uncover its cause should focus on this age group,” said Guillaume Savoye, MD, EPIMAD registry and department of gastroenterology, University Hospital, Rouen, France.

All very interesting (and yet troubling) trends.