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Inflammatory Bowel Diseases, A Long Way Ahead

1 Department of Gastroenterology, University Hospitals of Leicester, Leicester, UK
*Corresponding author: John F.Mayberry, Department of Gastroenterology, University Hospitals of Leicester, Leicester, UK. Tel.: +44-1162584786, E-mail:
Annals of Colorectal Research. 2013 September; 1(2): 73. , DOI: 10.17795/acr-14321
Article Type: Letter; Received: Aug 21, 2013; Accepted: Aug 24, 2013; epub: Jul 30, 2013; ppub: Sep 29, 2013

Keywords: Crohn’s; Ulcerative Colitis; Epidemiology

Dear Editor,

This study from Shiraz is an important contribution to our understanding of the epidemiology of inflammatory bowel disease. It also offers an opportunity to investigate those environmental factors that are operational in the increase of incidence that has been seen in a number of countries. The epidemiology of IBD in Shiraz shows the classical features of a condition that first emerges in urban areas with the dominant condition initially ulcerative colitis. With time there is a move towards equality of the two conditions and a disappearance of the urban/rural divide (1). We have no understanding as to why this happens. However, with the sophisticated techniques now available to both epidemiologists and laboratory scientists it is possible that Shiraz and other areas of Iran could provide the answer. One exciting difference reported in this paper is the absence of a significant role for tobacco use. What does this mean and will a more clear role emerge as the disease incidence increases.

I would encourage the authors to plan a prospective study to investigate the incidence in Shiraz over the coming quinquenium. There is also the intriguing possibility that the group working in Shiraz could co-ordinate a study of Crohn’s disease in migrant communities (2). There is evidence from work done on South Asian migrants that the disease can become more severe in the second or in those who migrated when young. Such studies will provide a fertile ground for investigating potential aetiological factors including milk and sugar as well tobacco and genetic factors.


Financial Disclosure: There is no financial or other conflicts of interest.


  • 1. Taghavi SA, Safarpour AR, Hoseini SV, Safarpour M, Noroozi H. Epidemiology of Inflammatory Bowel Diseases (IBD) in Iran: A review of 740 patients in Fars province, Southern Iran. Ann Colorectal Res. 2013;1(1):17-22.
  • 2. Carr I, Mayberry JF. The effects of migration on ulcereative colitis: a three-year prospective study among Europeans and first and second generation South Asians in Leicester (1991-1994). American J Gastroenterol. 1999;94:2918-22.