Predisposing factors

There are many suggested predisposing factors related to the development of IBD. The tendency for IBD to occur in populations living in Northern Europe and North America has inevitably suggested a causal link with dietary habits, particularly with dietary fibre and sugar consumption.

Since IBD tends to develop in young adults, factors occurring in childhood have been proposed; breast feeding exerts a protective influence, but whether protection is a direct consequence of breast feeding or whether it arises from associated factors is unknown. One factor may be smoking and there is a large body of evidence indicating that patients with ulcerative colitis are likely to be non-smokers, whereas those with Crohn's disease tend to be smokers. Patients with Crohn's disease who do smoke have more relapses, hospital admissions, surgery and higher blood leukocyte counts than non-smokers. Thus smoking may be a risk factor for the development of Crohn's disease and is associated with more severe disease.

Studies have shown that both Crohn's disease and ulcerative colitis occur more commonly than expected by chance within families. For example, a study in Wales showed that the prevalence of IBD in siblings of patients affected by Crohn's disease was almost 30 times greater than the community prevalence. In addition, when one of the diseases occurs in one family member, the same disease is more likely to manifest itself within the family. This pattern could arise from either common, predisposing genetic factors within the family or common environmental influences.

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