Published online Oct 7, 2020. doi: 10.3748/wjg.v26.i37.5661
Peer-review started: May 18, 2020
First decision: July 29, 2020
Revised: August 7, 2020
Accepted: September 16, 2020
Article in press: September 16, 2020
Published online: October 7, 2020
Environmental factors in addition to genetic and immunological factors are known to influence on the development of inflammatory bowel disease (IBD) including Crohn’s disease (CD) and ulcerative colitis (UC). The effects of etiologies such as smoking, alcohol consumption, age and comorbidities on the occurrence of chronic intestinal inflammation may vary based on race and gender.
Gut dysbiosis is associated with IBD as a cause or result and is related to oral microflora. Oral disease can occur as an extra-intestinal manifestation of IBD. However, the risk of developing IBD in patients with periodontitis remains unclear.
We aimed to evaluate the risk of developing IBD in patients with periodontitis and to determine the combined effect of risk factors on the development of IBD associated with periodontitis.
Using database of the National Health Insurance and National Health Screening Program in South Korea in 2009, we compared people with and without periodontitis and evaluated newly diagnosed IBD in both group during follow-up period until 2017. All 9950548 people over the age of 20 who received a national health check in 2009 were included. Periodontitis was defined using the International Classification of Disease 10th revision (ICD-10). CD and UC were defined using ICD-10 and rare intractable disease codes specific to South Korea.
Out of 9950548 individuals, a total of 1092825 subjects (11.0%) had periodontitis. The periodontitis group was older and had a higher male proportion. During the median follow-up period of 7.26 years, people with periodontitis had a significantly higher risk of developing UC than those without periodontitis. In a subgroup analysis, current smokers aged 65 and older with periodontitis had a 1.9-fold increase in UC risk than non-smokers aged 65 and older without periodontitis.
Periodontitis is highly associated with the risk of developing UC, especially in current smokers over 65. It suggests that periodontitis and current smoking are a potential combined risk factor for the development of elderly-onset UC.
Based on the results of this study, we need future prospective studies to focus on the synergistic impacts of the environmental risk factors on elderly onset UC in terms of complex interaction of oral and intestinal microflora. Ultimately, it can lead to a better understanding of the pathogenesis of IBD.