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P341. Association of hygienic factors and inflammatory bowel disease in Rio de Janeiro, Brazil

V. Salgado, N. Boechat, M.H.D.M. Costa, C. Zaltman

Hospital Universitario Clementino Fraga Filho, Rio de Janeiro, Brazil

Aim: Identify hygienic risk factors possibly associated with the development of inflammatory bowel disease (IBD) in patients from a reference center from a University Hospital in Rio de Janeiro, Brazil.

Methods: The research was performed at HUCFF – UFRJ, a university hospital and reference center for IBD treatment, between June/2008 and November/2009. The study was approved by The University Hospital Ethics Committee and patients agreed in participating signing the informed consent. A hospital-based case–control study was carried out with a total of 145 cases of Crohn's disease (CD) and 100 of ulcerative colitis (UC) that were compared with 163 sex and age matched healthy controls, living in the same area. A multi-item questionnaire with 94 questions regarding familial history of IBD, perinatal and childhood circumstances and familial socioeconomic status was carried out by an interviewer.

Just adults between 18 yrs and 80 yrs were included, and patients with psychiatric or comprehension disturbs were not included in the study.

Statistical analysis was performed using the statistical software SAS 6.11 (SAS Institute, Inc., Cary, North Carolina). Fisher exact test, Yates' corrected chi-square and the one-way ANOVA-test in which pairwise multiple comparisons were carried out. Values are expressed as means ± SEM. The level of significance was set at p < 0.05.

Results: The worst sanitary conditions reflected by the absence of piped water and sewer network were most frequently observed in controls (41.1%) than in CD (17.9%) (p < 0.0001). The consumption of inadequate water during childhood was most prevalent in UC (14%) and controls (8.6%) when compared to CD (2.1%) (p = 0.002). Waste management was more inappropriate in control group (51.5%) than in CD (23.5%) and UC (28%) (p < 0.0001). There was also a significantly difference in family size among the groups (p = 4.0), with small families in CD than in UC and controls. Rural environment, pets and previous infection with measles, mumps, pertussis were higher in UC or controls compared with CD. Intestinal infections were often observed in CD but helminths infections had no difference among the three groups.

Conclusion: These results reinforce the “IBD hygiene hypothesis” that extremely hygienic environments and a lesser exposure to infections in childhood, negatively affects immune development, predisposing them to immunological diseases like IBD later in life, mainly CD. The absence of relation between helminths infection and IBD development is unsure in literature but may reflect in the study population the high local prevalence o these condition and can be considered an isolated environmental risk factor.