Causes and Risk Factors of Inflammatory Bowel Disease

There are several theories about what causes inflammatory bowel disease (IBD), but none are confirmed. As an idiopathic disease, or one of unknown cause, it may be that one or several factors give rise to the diseases that comprise IBD (ulcerative colitis, Crohn's disease, and indeterminate colitis). A malfunctioning immune system, genetics, other conditions, and certain risk factors may all potentially play a role.

While it was once thought that what you eat and your stress levels could cause IBD, that is no longer the case. (Though they can induce an IBD flare in those who have the condition.)

IBD is frequently called autoimmune disease, a disease that is triggered by the immune system, but it is more accurate to say that it is an immune-mediated response. Seasonal flare-ups—during the spring or autumn—sometimes occur in people with IBD.

One theory is that IBD is an IgE-mediated allergic response. The allergic response sets off a chain of events resulting in an excess of eosinophils (cells that try to fight the allergic response) in the body.

These eosinophils release four toxic compounds, three of which are found in statistically significant amounts in the stool of IBD patients (via a fecal calprotectin test). This leads some researchers to conclude that an allergic response may have a role in the development of IBD.

Another strong area of research is the role that cytokines play in the development of IBD. Cells called tumor necrosis factor (TNF, tumor necrosis factor-alpha) are responsible for regulating the immune response, among other functions.

Here too, TNF is found in higher quantities in the stool of people with IBD than it is in people who do not have IBD.

Several anti-TNF drugs (commonly called biologics) have been developed to treat IBD. The success of these medications lends some weight to the idea that TNF plays some role in causing IBD or the inflammation associated with IBD flare-ups.

Years ago, it was thought that IBD might run in families, but the link seemed tenuous because it was not a direct parent-to-child situation, as is the case with some inherited conditions.

But with the discovery of hundreds of genes that may be associated with IBD, it has become apparent that there is a hereditary component to it. First-degree relatives of people who have IBD are significantly more likely to also have the disease.

Some research points at a few possibilities for the reason some people who have IBD genes develop IBD and other people do not. Still, the majority of people who have IBD have no family history.

Given that some people with the same genes develop IBD, while others do not, something other than genetics needs to be taken into consideration when looking at the possible causes of IBD.

There are some clear trends in the epidemiology of IBD that may point to one or more environmental causes. IBD tends to occur most often in developed countries and amongst those with higher socioeconomic status. IBD also tends to occur more often in the urban areas of developed countries.

These factors have led researchers to think that there may be some connection between IBD and the lifestyles or environment of people living in developed countries, although no one knows yet what this could be.

One suggested theory is that industrialized nations are "too clean", and because children and adolescents are exposed to fewer bacteria, their immune systems may be inadequate, which leads to autoimmune disease.

While the exact cause of IBD is not clear, experts know so much more about the disease now than just a decade ago. More research is being done, and scientists are getting closer and closer to understanding how doctors can treat IBD more effectively and prevent it in future generations.