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P648. Environmental factors prior to IBD diagnosis in Europe – an ECCO–EpiCom study

J. Burisch1, R. Seerup1, S. Cukovic-Cavka2, I. Kaimakliotis3, D. Duricova4, O. Shonova5, I. Vind6, N. Pedersen1, E. Langholz7, N. Thorsgaard8, V. Andersen9, J.F. Dahlerup10, R. Salupere11, K.R. Nielsen12, P. Manninen13, E. Tsianos14, K. Ladefoged15, E. Björnsson16, Y. Bailey17, S. Odes18, M. Martinato19, L. Kupcinskas20, S. Turcan21, F. Magro22, A. Goldis23, E. Belousova24, V. Hernandez25, S. Almer26, J. Halfvarson27, N. Arebi28, S. Sebastian29, P. Lakatos30, P. Munkholm1, 1Herlev University Hospital, Department of Gastroenterology, Copenhagen, Denmark, 2University Hospital Rebro, Division of Gastroenterology and Hepatology, Zagreb, Croatia, 3Nicosia private practice, Nicosia, Cyprus, 4Charles University, IBD Center ISCARE, Prague, Czech Republic, 5Hospital Ceske Budejovice, Gastroenterology Department, Ceske Budejovice, Czech Republic, 6Amager Hospital, Department of Medicine, Amager, Denmark, 7Gentofte Hospital, Department of Medical Gastroenterology, Gentofte, Denmark, 8Herning Central Hospital, Department of Medicine, Herning, Denmark, 9Viborg Regional Hospital, Medical department, Viborg, Denmark, 10Arhus University Hospital, Department of Medicine V (Hepatology and Gastroenterology), Aarhus, Denmark, 11Tartu University Hospital, Division of Endocrinology and Gastroenterology, Tartu, Estonia, 12The National Hospital of the Faroe Islands, Medical department, Torshavn, Faroe Islands, 13Tampere University Hospital, Department of Gastroenterology and Alimentary Tract Surgery, Tampere, Finland, 14University Hospital, 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, Ioannina, Greece, 15Dronning Ingrids Hospital, Medical department, Nuuk, Greenland, 16The National University Hospital, Department of Internal Medicine, Section of Gastroenterology and Hepatology, Reykjavik, Iceland, 17Adelaide and Meath Hospital, TCD, Department of Gastroenterology, Dublin, Ireland, 18Soroka Medical Center and Ben Gurion University of the Negev, Department of Gastroenterology and Hepatology, Beer Sheva, Israel, 19On behalf of the EpiCom Northern Italy center based in Crema, Cremona, Firenze, Forlì, Padova and Reggio Emilia, Italy, 20Lithuanian University of Health Sciences, Institute for Digestive Research, Kaunas, Lithuania, 21State University of Medicine and Pharmacy, Laboratory of Gastroenterology, Medical Clinic IY, Chisinau, Moldova, Republic of, 22Hospital de São João, Department of Gastroenterology, Porto, Portugal, 23University of Medicine ‘Victor Babes’, Clinic of Gastroenterology, Timisoara, Romania, 24Moscow Regional Research Clinical Institute, Department of Gastroenterology, Moscow, Russian Federation, 25Complexo Hospitalario Universitario de Vigo, Gastroenterology Department, Vigo, Spain, 26Department of Clinical and Experimental Medicine, Linköping University, Division of Gastroenterology and Hepatology, Linköping, Sweden, 27Örebro University Hospital and School of Health and Medical Sciences, Örebro University, Department of Medicine, Division of Gastroenterology, Örebro, Sweden, 28St. Mark's Hospital, Imperial College London, London, United Kingdom, 29Hull and East Yorkshire NHS Trust & Hull and York Medical School, Hull Royal Infirmary, Hull, United Kingdom, 30Semmelweis University, 1st Department of Medicine, Budapest, Hungary


Recent studies from the Eastern European countries (EEC) such as Hungary and Croatia have reported sharp increases in IBD incidence, leaving these populations at comparable incidence levels as in Western European countries (WEC). Changes in lifestyle in EEC throughout the last couple of decades have resulted in a more “Westernized” way of life and environmental factors might be an explanation for the observed increase in incidence. The EpiCom-study was initiated in 30 centres from 14 WEC and 8 EEC to investigate the differences in incidence and impact of environmental factors.


The EpiCom cohort is a prospective, uniformly diagnosed by international criteria, population-based cohort of 1515 patients aged 15 or older diagnosed with IBD within 2010 and followed up until 1.1.2012. At the time of diagnosis all patients were handed a questionnaire concerning environmental factors assumed to be risk factors or to protect against the development of IBD. The questionnaire consists of 87 questions and has been proposed by the International Organization of Inflammatory Bowel Disease (IOIBD). The patients were entered in a web-based database (


247 (21%) patients from EEC and 917 (79%) from WEC completed the questionnaire. Of the patients from EEC 100 (40%) were diagnosed with Crohn's disease (CD), 141 (57%) with ulcerative colitis (UC) and 6 (3%) with IBD type unclassified (IBDU). From WEC 335 (37%) patients had CD, 475 (52%) UC and 107 (12%) IBDU. Regarding smoking status at diagnosis, 25 (46%) CD patients from EEC were smokers at the time of diagnosis compared to 129 (66%) from WEC (p < 0.01). 34 (62%) UC patients from EEC and 162 (78%) from WEC were former smokers. High consumption of fibre may protect against IBD whereas high consumption of sugar may be a risk factor. Patients from EEC had a lower intake of fibre (40% vs. 57%, p < 0.01) and a higher intake of sugar (71% vs. 48%, p < 0.01) compared to patients from WEC. No difference in intake of fast-food was found between the two regions. Regarding childhood vaccinations surprisingly more patients from EEC were vaccinated compared to patients from WEC (p < 0.001) except for polio and tetanus. No differences were found regarding appendectomy and tonsillectomy.


The two regions differ in terms of exposure to environmental factors prior to the diagnosis. Analysis of the impact of environmental factors on difference in disease course and incidence in the EpiCom cohort are currently in progress.