Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Epidemiology and environmental factors in inflammatory bowel disease in children and adolescents

Leslie M Higuchi, MD, MPH
Athos Bousvaros, MD
Section Editor
Melvin B Heyman, MD, MPH
Deputy Editor
Alison G Hoppin, MD


Inflammatory bowel disease (IBD) is comprised of two major disorders: ulcerative colitis (UC) and Crohn disease (CD). UC affects the colon, whereas CD can involve any component of the gastrointestinal tract from the oral cavity to the anus. These disorders have distinct pathologic and clinical characteristics, but their pathogenesis remains poorly understood. (See "Immune and microbial mechanisms in the pathogenesis of inflammatory bowel disease".)

The peak incidence of IBD occurs in patients between the ages of 15 and 30 years [1,2]. Approximately 20 percent of patients with CD and 12 percent of patients with UC develop their IBD before the age of 20 years [3]. Both adults and children with IBD may present with similar clinical features; however, children can develop unique complications, including growth failure and delayed puberty. Clinicians caring for children and adolescents with one of these disorders must treat the underlying disease and its complications and must also carefully monitor linear growth, skeletal development, and puberty.

The epidemiology and role of environmental factors in IBD in children and adolescents will be reviewed here. The clinical manifestations, diagnosis, and treatment of CD and UC in children and adolescents and the role of genetic factors are presented in separate topic reviews:

(See "Clinical presentation and diagnosis of inflammatory bowel disease in children".)

(See "Clinical manifestations of Crohn disease in children and adolescents".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: May 13, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Mendeloff AI, Calkins BM. The epidemiology of idiopathic inflammatory bowel disease. In: Inflammatory Bowel Disease, Kirsner JB, Shorter RG (Eds), Lea & Febiger, Philadelphia 1988. p.3.
  2. Johnston RD, Logan RF. What is the peak age for onset of IBD? Inflamm Bowel Dis 2008; 14 Suppl 2:S4.
  3. Kappelman MD, Moore KR, Allen JK, Cook SF. Recent trends in the prevalence of Crohn's disease and ulcerative colitis in a commercially insured US population. Dig Dis Sci 2013; 58:519.
  4. Miller RC, Larsen E. Regional enteritis in early infancy. Am J Dis Child 1971; 122:301.
  5. Chong SK, Blackshaw AJ, Morson BC, et al. Prospective study of colitis in infancy and early childhood. J Pediatr Gastroenterol Nutr 1986; 5:352.
  6. Gryboski JD. Ulcerative colitis in children 10 years old or younger. J Pediatr Gastroenterol Nutr 1993; 17:24.
  7. Mamula P, Telega GW, Markowitz JE, et al. Inflammatory bowel disease in children 5 years of age and younger. Am J Gastroenterol 2002; 97:2005.
  8. Heyman MB, Kirschner BS, Gold BD, et al. Children with early-onset inflammatory bowel disease (IBD): analysis of a pediatric IBD consortium registry. J Pediatr 2005; 146:35.
  9. Barton JR, Gillon S, Ferguson A. Incidence of inflammatory bowel disease in Scottish children between 1968 and 1983; marginal fall in ulcerative colitis, three-fold rise in Crohn's disease. Gut 1989; 30:618.
  10. Armitage E, Drummond H, Ghosh S, Ferguson A. Incidence of juvenile-onset Crohn's disease in Scotland. Lancet 1999; 353:1496.
  11. Turunen P, Kolho KL, Auvinen A, et al. Incidence of inflammatory bowel disease in Finnish children, 1987-2003. Inflamm Bowel Dis 2006; 12:677.
  12. Schildkraut V, Alex G, Cameron DJ, et al. Sixty-year study of incidence of childhood ulcerative colitis finds eleven-fold increase beginning in 1990s. Inflamm Bowel Dis 2013; 19:1.
  13. Benchimol EI, Manuel DG, Guttmann A, et al. Changing age demographics of inflammatory bowel disease in Ontario, Canada: a population-based cohort study of epidemiology trends. Inflamm Bowel Dis 2014; 20:1761.
  14. Sonnenberg A, McCarty DJ, Jacobsen SJ. Geographic variation of inflammatory bowel disease within the United States. Gastroenterology 1991; 100:143.
  15. Shivananda S, Lennard-Jones J, Logan R, et al. Incidence of inflammatory bowel disease across Europe: is there a difference between north and south? Results of the European Collaborative Study on Inflammatory Bowel Disease (EC-IBD). Gut 1996; 39:690.
  16. Khalili H, Huang ES, Ananthakrishnan AN, et al. Geographical variation and incidence of inflammatory bowel disease among US women. Gut 2012; 61:1686.
  17. Logan RF. Inflammatory bowel disease incidence: up, down or unchanged? Gut 1998; 42:309.
  18. Mayberry J, Mann R. Inflammatory bowel disease in rural sub-Saharan Africa: rarity of diagnosis in patients attending mission hospitals. Digestion 1989; 44:172.
  19. Calkins BM, Lilienfeld AM, Garland CF, Mendeloff AI. Trends in incidence rates of ulcerative colitis and Crohn's disease. Dig Dis Sci 1984; 29:913.
  20. Kurata JH, Kantor-Fish S, Frankl H, et al. Crohn's disease among ethnic groups in a large health maintenance organization. Gastroenterology 1992; 102:1940.
  21. AlSaleem K, El Mouzan MI, Saadah OI, et al. Characteristics of pediatric ulcerative colitis in Saudi Arabia: a multicenter national study. Ann Saudi Med 2015; 35:19.
  22. ACHESON ED. The distribution of ulcerative colitis and regional enteritis in United States veterans with particular reference to the Jewish religion. Gut 1960; 1:291.
  23. Fireman Z, Grossman A, Lilos P, et al. Epidemiology of Crohn's disease in the Jewish population of central Israel, 1970-1980. Am J Gastroenterol 1989; 84:255.
  24. Niv Y, Torten D, Tamir A, Epstein L. Incidence and prevalence of ulcerative colitis in the upper Galilee, Northern Israel, 1967-1986. Am J Gastroenterol 1990; 85:1580.
  25. Gilat T, Grossman A, Fireman Z, et al. Inflammatory bowel disease in Jews. Front Gastrointes Res 1986; 11:141.
  26. Van Limbergen J, Russell RK, Drummond HE, et al. Definition of phenotypic characteristics of childhood-onset inflammatory bowel disease. Gastroenterology 2008; 135:1114.
  27. Vernier-Massouille G, Balde M, Salleron J, et al. Natural history of pediatric Crohn's disease: a population-based cohort study. Gastroenterology 2008; 135:1106.
  28. Kugathasan S, Baldassano RN, Bradfield JP, et al. Loci on 20q13 and 21q22 are associated with pediatric-onset inflammatory bowel disease. Nat Genet 2008; 40:1211.
  29. Kappelman MD, Rifas-Shiman SL, Kleinman K, et al. The prevalence and geographic distribution of Crohn's disease and ulcerative colitis in the United States. Clin Gastroenterol Hepatol 2007; 5:1424.
  30. Davis MK. Breastfeeding and chronic disease in childhood and adolescence. Pediatr Clin North Am 2001; 48:125.
  31. Koletzko S, Sherman P, Corey M, et al. Role of infant feeding practices in development of Crohn's disease in childhood. BMJ 1989; 298:1617.
  32. Corrao G, Tragnone A, Caprilli R, et al. Risk of inflammatory bowel disease attributable to smoking, oral contraception and breastfeeding in Italy: a nationwide case-control study. Cooperative Investigators of the Italian Group for the Study of the Colon and the Rectum (GISC). Int J Epidemiol 1998; 27:397.
  33. Michelow IC, Yantosca LM, Karpel M, Schmidt EV. Complex role of mannose-binding lectin in infectious diseases. J Pediatr 2009; 155:301.
  34. Koletzko S, Griffiths A, Corey M, et al. Infant feeding practices and ulcerative colitis in childhood. BMJ 1991; 302:1580.
  35. Gilat T, Hacohen D, Lilos P, Langman MJ. Childhood factors in ulcerative colitis and Crohn's disease. An international cooperative study. Scand J Gastroenterol 1987; 22:1009.
  36. Hutfless S, Li DK, Heyman MB, et al. Prenatal and perinatal characteristics associated with pediatric-onset inflammatory bowel disease. Dig Dis Sci 2012; 57:2149.
  37. Glassman MS, Newman LJ, Berezin S, Gryboski JD. Cow's milk protein sensitivity during infancy in patients with inflammatory bowel disease. Am J Gastroenterol 1990; 85:838.
  38. Kronman MP, Zaoutis TE, Haynes K, et al. Antibiotic exposure and IBD development among children: a population-based cohort study. Pediatrics 2012; 130:e794.
  39. Haga Y, Funakoshi O, Kuroe K, et al. Absence of measles viral genomic sequence in intestinal tissues from Crohn's disease by nested polymerase chain reaction. Gut 1996; 38:211.
  40. Haslam N, Mayberry JF, Hawthorne AB, et al. Measles, month of birth, and Crohn's disease. Gut 2000; 47:801.
  41. Feeney M, Ciegg A, Winwood P, Snook J. A case-control study of measles vaccination and inflammatory bowel disease. The East Dorset Gastroenterology Group. Lancet 1997; 350:764.
  42. Davis RL, Kramarz P, Bohlke K, et al. Measles-mumps-rubella and other measles-containing vaccines do not increase the risk for inflammatory bowel disease: a case-control study from the Vaccine Safety Datalink project. Arch Pediatr Adolesc Med 2001; 155:354.
  43. Radon K, Windstetter D, Poluda AL, et al. Contact with farm animals in early life and juvenile inflammatory bowel disease: a case-control study. Pediatrics 2007; 120:354.
  44. Lashner BA, Loftus EV Jr. True or false? The hygiene hypothesis for Crohn's disease. Am J Gastroenterol 2006; 101:1003.
  45. Amre DK, Lambrette P, Law L, et al. Investigating the hygiene hypothesis as a risk factor in pediatric onset Crohn's disease: a case-control study. Am J Gastroenterol 2006; 101:1005.
  46. Gent AE, Hellier MD, Grace RH, et al. Inflammatory bowel disease and domestic hygiene in infancy. Lancet 1994; 343:766.
  47. Sakamoto N, Kono S, Wakai K, et al. Dietary risk factors for inflammatory bowel disease: a multicenter case-control study in Japan. Inflamm Bowel Dis 2005; 11:154.
  48. Tragnone A, Valpiani D, Miglio F, et al. Dietary habits as risk factors for inflammatory bowel disease. Eur J Gastroenterol Hepatol 1995; 7:47.
  49. Ananthakrishnan AN, Khalili H, Konijeti GG, et al. Long-term intake of dietary fat and risk of ulcerative colitis and Crohn's disease. Gut 2014; 63:776.
  50. Ananthakrishnan AN, Khalili H, Konijeti GG, et al. A prospective study of long-term intake of dietary fiber and risk of Crohn's disease and ulcerative colitis. Gastroenterology 2013; 145:970.
  51. Ananthakrishnan AN, Khalili H, Higuchi LM, et al. Higher predicted vitamin D status is associated with reduced risk of Crohn's disease. Gastroenterology 2012; 142:482.
  52. Hou JK, Abraham B, El-Serag H. Dietary intake and risk of developing inflammatory bowel disease: a systematic review of the literature. Am J Gastroenterol 2011; 106:563.
  53. Belluzzi A, Brignola C, Campieri M, et al. Effect of an enteric-coated fish-oil preparation on relapses in Crohn's disease. N Engl J Med 1996; 334:1557.
  54. Stenson WF, Cort D, Rodgers J, et al. Dietary supplementation with fish oil in ulcerative colitis. Ann Intern Med 1992; 116:609.
  55. Hartmann G, Endres S. n-3 polyunsaturated fatty acids and human cytokine synthesis. In: Handbook of Essential Fatty Acid Biology: Biochemistry, Physiology, and Behavioral Biology, Yehoda S, Mostofsky D (Eds), Humana Press, Totawa 1997. p.103.
  56. Hillier K, Jewell R, Dorrell L, Smith CL. Incorporation of fatty acids from fish oil and olive oil into colonic mucosal lipids and effects upon eicosanoid synthesis in inflammatory bowel disease. Gut 1991; 32:1151.
  57. Sonnenberg A. Geographic variation in the incidence of and mortality from inflammatory bowel disease. Dis Colon Rectum 1986; 29:854.
  58. Shoda R, Matsueda K, Yamato S, Umeda N. Epidemiologic analysis of Crohn disease in Japan: increased dietary intake of n-6 polyunsaturated fatty acids and animal protein relates to the increased incidence of Crohn disease in Japan. Am J Clin Nutr 1996; 63:741.
  59. Lev-Tzion R, Griffiths AM, Leder O, Turner D. Omega 3 fatty acids (fish oil) for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev 2014; :CD006320.
  60. Higuchi LM, Khalili H, Chan AT, et al. A prospective study of cigarette smoking and the risk of inflammatory bowel disease in women. Am J Gastroenterol 2012; 107:1399.
  61. Mahid SS, Minor KS, Soto RE, et al. Smoking and inflammatory bowel disease: a meta-analysis. Mayo Clin Proc 2006; 81:1462.
  62. Mahid SS, Minor KS, Stromberg AJ, Galandiuk S. Active and passive smoking in childhood is related to the development of inflammatory bowel disease. Inflamm Bowel Dis 2007; 13:431.