Geographical variability and environmental risk factors in inflammatory bowel disease

Siew C. Ng, Charles N. Bernstein, Morten H. Vatn, Peter Laszlo Lakatos, Edward V. Loftus, Curt Tysk, Colm O'Morain, Bjorn Moum, Jean Frédéric Colombel

Research output: Contribution to journalArticlepeer-review

322 Scopus citations


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, countrybased 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.

Original languageEnglish (US)
Pages (from-to)630-649
Number of pages20
Issue number4
StatePublished - Apr 2013

ASJC Scopus subject areas

  • Gastroenterology


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