Developing IBD & the Influence of Environmental Factors 

Dr. Nandi:
You’re listening to GI Insights on ReachMD. I’m Dr. Neil Nandi, and I recently had the chance to sit down with Dr. Maria Abreu, the Director of the Crohn’s and Colitis Center at the University of Miami. In this commentary she shares her brilliant insights into how environmental factors contribute to the pathogenesis and development of inflammatory bowel disease.

Dr. Abreu:
I think that when one does research, whether the research is basic research or clinical research, it needs to be inspired by what you are seeing in the clinic every day. And I moved back to Miami maybe 11 years ago, and one of the things that was very striking was that our IBD clinic was full of mostly Cubans, but of course, you know, Miami is the capital of Latin America, and so we really represent the diaspora of a lot of different Latin America countries, Cubans, numerically the most, but you know, Columbians and Nicaraguans have been here, also, a long time. And it was like a mini-epidemic of either first generation Hispanic-Americans or people that come from other countries and had developed IBD here. And I’m often asked, well, how do you know that they didn’t really already have it and it wasn’t diagnosed in their country? In reality, when we collect information on the database, we ask them information about when they had symptoms initially and when were they officially diagnosed, and whatever way you look at it, the majority of people, at least for now, are developing IBD once they get to the United States of America. And Oriana Damas has done some really lovely work where she has found that, in the past, if someone came from Cuba to the United States, it would take them, on average, almost 30 years to develop IBD in this country. The meantime that it’s taking from immigration to diagnosis of IBD now is down to 8 years, and I would argue that it’s even getting shorter and shorter and we’re also seeing a shift that these immigrants are developing Crohn's disease right off the bat, rather than, you know, sort of, traditionally ulcerative colitis. So, that led us to, kind of, think about, “Well, what’s up with that?”, right, “What could be driving this very abrupt change, and sort of, unmasking, if you will, of this predisposition to developing IBD?” And Oriana has also studied this a bit in Hispanics that have developed IBD compared to those that haven’t; we have to acknowledge that diet studies where you’ll try to get people to remember what they ate, of course, can be flawed, but using the best methodology available, she found that those Cuban immigrants that developed IBD were more likely to report changing their diet to a more “American” or “Western” diet from their traditional diet. So, to the extent that we could ascertain it, if you embraced American culture in its totality, including its junk food, you’re worse off, at least with respect to developing an increased risk of IBD.

Dr. Nandi:
That was Dr. Maria Abreu from the Crohn’s and Colitis Center at the University of Miami enlightening us on how environmental factors can influence the development of IBD. For ReachMD, I’m Dr. Neil Nandi. To hear my full conversation with Dr. Abreu and to access other episodes in this series, please visit ReachMD.com/GIInsights, where you can Be Part of the Knowledge. Thanks for listening.