Results from a recent study published in the journal Inflammatory Bowel Disease show that adults who were physically or sexually abused during childhood are at increased risk for developing ulcerative colitis.
“We found that one-quarter of adults with ulcerative colitis reported they had been physically abused during their childhood, compared to one in 10 of those without inflammatory bowel disease,” Esme Fuller-Thomson, PhD,who holds the Sandra Rotman Endowed Chair at University of Toronto’s Factor-Inwentash Faculty of Social Work, said in a press release. “Similarly, the prevalence of childhood sexual abuse among those with ulcerative colitis was one in five versus one in 17 among those without the disease.”
In the study titled “Childhood Maltreatment Is Associated with Ulcerative Colitis but Not Crohn’s Disease: Findings from a Population-based Study,” Fuller-Thomson from the University of Toronto in Canada and colleagues conducted a secondary data analysis of a subsample of the nationally representative 2012 Canadian Community Health Survey—Mental Health consisted of those with no missing data on any of the variables of interest (n ¼ 21,852).
The survey response rate was 68.9%. Logistic regression was used to estimate odds ratios of 3 types of childhood adversities (physical abuse, sexual abuse, and witnessing parental domestic violence) separately for ulcerative colitis and Crohn’s disease, each compared with those without IBD. The final model controls for sociodemographics, health behaviors, and mental health.
The exposure was assessed by retrospective self-report, and the outcome was by self-report based on a professional diagnosis.
The results showed that in comparison to individuals who had not experienced physical abuse, “the odds of ulcerative colitis were more than two times higher for those who reported that an adult had at least once kicked, bit, punched, choked, burned or physically attacked them before the age of 16,” Joanne Sulman, MSW,adjunct lecturer at University of Toronto, said in the release.
“Occurrences of ulcerative colitis were also more than twice as high in individuals who reported that during their childhood an adult had forced them or attempted to force them into any unwanted sexual activity, by threatening them, holding them down or hurting them, in comparison to those who had not been sexually abused. These strong associations remained even after we took into account sociodemographic characteristics, mental health conditions and health behaviors.”
In a fully adjusted model, those who are physically (odds ratio ¼ 2.28; confidence interval, 1.39–3.75) or sexually abused (odds ratio ¼ 2.64; confidence interval, 1.61–4.33) during childhood had significantly higher odds of ulcerative colitis than their non-maltreated peers.
“In contrast to the strong association between childhood maltreatment and ulcerative colitis, we found no association between either type of abuse and Crohn’s disease,” Keri J. West, MSW, a master’s student at University of Toronto, said in the release. “This was very surprising because Crohn’s disease and ulcerative colitis are two forms of inflammatory bowel disease and we expected that similar links would be apparent for the two disorders. We do not know why these differences exist but it’s possible that epigenetics plays a role.”
“This research was based on a cross-sectional survey and therefore we cannot determine a cause and effect relationship,” Stephanie L. Baird, MSW, said in the release. “However, with such a high proportion of subjects with ulcerative colitis reporting childhood maltreatment, future research is clear[ly] warranted.”
According to the researchers, future studies should examine the potential pathways through which early adversities are linked with ulcerative colitis.
Inflammatory bowel disease (IBD) is a broad term that comprises idiopathic immune-mediated chronic inflammatory disorders of the gastrointestinal tract. The two primary types of IBD are Crohn’s disease and ulcerative colitis. Both are characterized by an abnormal immune response to innocuous substances or bacteria in the intestine. An estimated 1.4 million Americans are affected by IBD.
In North America, the prevalence of Crohn’s disease and ulcerative colitis is 319 per 100,000 persons and 249 per 100,000 persons, respectively.