Abstract
In this thesis, the role of environmental and lifestyle factors, the exposome, in etiology as well as course of disease of Inflammatory Bowel Disease (IBD) was examined. After development and validation of the Groningen IBD Environmental questionnaire (GIEQ), a large number of exposome factors was studied by comparing patients with IBD to population-based controls from the Lifelines Cohort study, identifying novel, modifiable, exposome factors possibly involved in disease development, among which prenatal smoke exposure. A large number of exposome factors was also examined for their association with development of disease complications such as the need for biological therapy, IBD-related surgery and development of colorectal neoplasia (CRN). Physical activity for example, was shown to have a beneficial effect, while a high visceral fat volume increased risk of disease-related complications. Also, this thesis shed light on the controversial association of the Mycobacterium Avium Paratuberculosis (MAP) and IBD. While using stringent criteria for test quality and repeatability, this thesis shows an increased use of biological therapy in those with a high immune response to MAP. Finally, cigarette smoke exposure was associated with CRN development in IBD with a clear improvement of risk stratification over the current surveillance guidelines used. These studies have once more shown the importance of the exposome, which offers the possibility of chance. An opportunity that shouldn’t be overlooked by researchers nor clinicians.
Original language | English |
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Qualification | Doctor of Philosophy |
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Award date | 3-Mar-2021 |
Place of Publication | [Groningen] |
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Publication status | Published - 2021 |