Identification of demographic and environmental factors predisposing to ulcerative colitis in southern India
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LETTER
Identification of demographic and environmental factors predisposing to ulcerative colitis in southern India Mayank Jain 1 & Jayanthi Venkataraman 1
# Indian Society of Gastroenterology 2020
Sir We read with immense interest the recent paper [1] highlighting the risk factors for inflammatory bowel disease (IBD) in western India. The authors noted that the significant risk factors for ulcerative colitis (UC) included higher education, professional occupation, higher family income, being married, and appendectomy, whereas vegetarian diet was protective against UC. There was no effect of area of residence, smoking, and alcohol intake. As a corollary to the paper, we would like to highlight our experience in southern Indian patients with UC. We conducted a prospective, questionnaire-based study to determine the impact of demographic, environmental, and familial risk factors in UC patients. The study was done at Gleneagles Global Health City, Chennai, between January and December 2017, and was approved by the Institutional Ethics Committee. A total of 95 known cases of UC were recruited and compared with 142 healthy volunteers from the hospital employees. Diagnosis of UC was confirmed based on clinical, endoscopic, and histological features. Median duration of the disease was 3.5 years (6 months–6 years). Questionnaire was completed by personal interview. Patient information recorded included age, sex, occupation, residence, education, marital status at the time of diagnosis, diet, socioeconomic class, history of past appendectomy, family history of IBD and details of smoking, alcohol, analgesic use, and oral contraceptive pills usage. The data were collected and entered in Microsoft Excel sheet. Comparison was done using Chi-square test, and p-value < 0.05 was considered significant. Study cohort included 95 patients (median age 43.6 years; men 48). The extent of UC was as follows—left sided colitis (48, 50.5%); pancolitis (30, 31.6%); and proctitis (17, 17.9%). As shown in Table 1, we noted that UC is commoner in women, * Mayank Jain [email protected] 1
Department of Gastroenterology, Gleneagles Global Health City, Chennai 600 100, India
in urban dwellers, and in clerical service/market workers. Education status, socioeconomic status, family history, dietary habits, smoking, alcohol intake, and history of appendectomy had no impact on occurrence of UC. It was interesting to note that alcohol intake was strongly associated (inversely) with UC. The odds of developing UC were highest with urban residence (5.12, CI 2.88–9.1, p < 0.0001), followed by female sex (1.97, CI 1.16–3.37, p 0.01). The present study has a few limitations. It is a corporate hospital–based study with small sample size and predominantly urban patients. Moreover, we took controls from the healthy hospital employees who may not be representative of the community. Despite this, it identifies certain demographic factors likely to influence the development of UC. A study from northern India demonstrated that better toilet facilit
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