The very high level of clustering of Crohn's Disease.

[kiny]

Van Kruiningen his old studies showed the fact Crohn's Disease features high level of clustering in Northern France and Belgium.

It is only when you look at recent detailed maps when you start to appreciate the level of clustering. There is a major environmental factor involved in crohn's disease.

https://onlinelibrary.wiley.com/doi/10.1111/apt.15512

Fine-scale geographical distribution and ecological risk factors for Crohn's disease in France (2007-2014)

University of Lille, Lille, France

Background
Geographical variations in Crohn's disease (CD) suggest that the environment has a role in the pathogenesis of this condition.

Aims
To describe the spatial distribution and the clustering of CD cases in France, and to assess the relationship between the prevalence of CD and environmental risk factors.

Methods
We identified all patients with CD included in the French hospital discharge database from 2007 to 2014. Age- and gender-smoothed standardised prevalence ratios over this period were computed for 5610 spatial units. An ecological regression analysis was used to assess the relationship between the risk of CD and ecological variables (health care, latitude, socio-economic deprivation, urbanisation, proportion of agricultural surfaces and density of industries). Local spatial clusters of high-CD prevalence were searched for using elliptic spatial scan statistics and characterised in a hierarchical ascendant classification based on the same ecological variables.

Results
About 129 089 patients with CD were identified, yielding a crude prevalence of 203 per 100 000 inhabitants. The overall spatial heterogeneity was statistically significant (P < .001). An elevated risk of CD was found to be significantly associated with high-social deprivation (relative risk [95% confidence interval] = 1.05 [1.02-1.08]) and high urbanisation (1.09 [1.04-1.14]). Sixteen significant spatial clusters of high-CD prevalence were identified; there were no common ecological variables.

Conclusions
The geographical distribution of CD prevalence in France is not uniform, and is associated with high levels of social deprivation and urbanisation. Larger ecological databases integrating more detailed environmental and clinical information are needed.

 

[kiny]

You can not explain this with genetics at all btw.

If crohn's disease was purely genetic, concordance between monozygotic twins would be exactly the same. That is not the case at all for crohn's disease, in fact it is more likely that only 1 of the monozygotic twins develops crohn's disease than both.

Nor can you use genetics to explain this highly concentrated clustering within small areas, there is no genetic trait you can identify on such a small scale that could possibly explain this clustering.

If anyone has a possible explanation for this clustering, be my guest. Your guess is as good as the next one, because currently there is no explanation for this clustering. Even the idea that crohn's disease could be contagious is still on the table.

 

[kiny]

Van Kruiningen

When you read these clustering studies, you come to appreciate how weak this supposed "Western Diet" theory is. A family cluster that cooked its own fresh vegetables from the garden for crying out loud, they had a healthier diet than anyone I know.

The large european study showed no relationship between fiber intake and incidence of crohn's disease either.

https://academic.oup.com/ecco-jcc/article/12/2/129/4372232?login=false

In total, 401326 participants, aged 20–80 years, were recruited in eight countries in Europe between 1991 and 1998. The main finding of this study was that there were no associations in the whole cohort with the intakes of total fibre, or fibre from fruit, vegetables or cereals, and the subsequent development of either CD or UC.

"Western diet" or "low fiber" diet, does not explain crohn's disease at all and this supposed link has been thoroughly debunked in large European studies.

They should quit peddling this theory before crohn's disease patients start blaming themselves for something they had no control over.

 

[Waldo]

Interesting map. One correlation I can think of is the intensity of specific kinds of farming. This map shows the intensity of potato-growing, and it seems there is some correlation (not nessecarily causation). Maybe certain pesticides that end up in the watersupply play a role?? Just a guess.

 

[asadmom]

@kiny, in your opinion what is one discovery from the past say 10 years that is truly groundbreaking? VNS? Kelly Owens is managing her complex Crohn's purely through the vagal simulation and is in deep remission I believe for 5 years now. There is a VNS trial underway for RA and they are recruiting patients with UC. Other than VNS, it's more drug and talk on diet.

 

[kiny]

Maybe certain pesticides that end up in the watersupply play a role?? Just a guess.

It's a good suggestion. I would have to check what type of water they drank in other studies of clusters.

Family 1 drank bottled mineral water.



Family 2 family drank bottled water and farm spring water.

 

[kiny]

@kiny, in your opinion what is one discovery from the past say 10 years that is truly groundbreaking? VNS? Kelly Owens is managing her complex Crohn's purely through the vagal simulation and is in deep remission I believe for 5 years now. There is a VNS trial underway for RA and they are recruiting patients with UC. Other than VNS, it's more drug and talk on diet.

Darfeuille-Michaud who discovered AIEC. The fact they seem to be able to heal fistula with stem cells. Advancements in ultrasound that would be much less invasive to crohn's disease patients than MRI or colonoscopy. We are getting somewhere.

I honestly don't know anything about the vagal stimulation to be honest. I have heard people talk about it though.

 

[asadmom]

'The inflammation reflex' by Dr. Kevin Tracey: https://www.researchgate.net/publication/10983143_The_inflammatory_reflex

He is also the one who helped Kelly Owen gain access to VNS: https://medium.com/authority-magazi...-made-incredible-accomplishments-ff0ab6e3df25

Would love to get your take on this completely different approach in managing inflammatory condition.

 

[Delta_hippo]

If anyone wants to try there is a Facebook group of mainly ME/ CFS patients who share info about the different types of vagus nerve stimulating machines you can get and their experiences google Dawn Wiley A Vagus Adventure. It’s mainly different types of TENS machines and ear clips and details of what frequency etc. I am thinking of giving it a try (for the Crohn’s but also autonomic nervous system problems) if I will do I will update.
Regarding the clustering there was a view a while ago about levels of bugs in water run off from farms whether that matches the maps above I have no idea. But if you are moving house then maybe downstream of an intensive farming area is something to avoid