Browsing by Author "Cruz, Eduardo Manuel Silva"
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- Effects of Environmental Contaminants in Inflammatory Bowel DiseasePublication . Cruz, Eduardo Manuel Silva; Pastorinho, Manuel Ramiro Dias; Sousa, Ana CatarinaIntroduction: The Inflammatory Bowel Disease is characterized by a chronic inflammation of the gastrointestinal tract and it has two important forms: Crohn’s Disease and Ulcerative Colitis. Although the pathophysiology of the disease is mostly unknown, an interaction between immune system, genetics, microbiome and environmental factors seem to be responsible for the disease onset. The role of environmental factors in the pathophysiology of this disease is reinforced if we consider the rapid growth in incidence and prevalence rates of Inflammatory Bowel Disease in areas where the incidence was low as for example Asia. However, the literature on the role of environmental factors in Inflammatory Bowel Disease is reduced and not systematized. Objectives: To study the effect of environmental contaminants on Inflammatory Bowel Disease through a systematic review of the literature. Methods: For this systematic review the methodology "Navigation Guide Method for Grading Human Evidence" was used. The research was carried out in three databases (Scopus, Web of Science, PubMed / MEDLINE). The inclusion criteria used were: research articles with original human data, clinically diagnosed Inflammatory Bowel Disease, quantification of environmental contaminants and study of the association between environmental contaminants and Inflammatory Bowel Disease. Only written articles Portuguese, English, French or Spanish were included. Results: Sixteen studies were included in this systematic review. Of these, 13 studied Inflammatory Bowel Disease in general, 2 studies included only patients with Crohn's Disease and 1 study included only patients with Ulcerative Colitis. The most studied environmental contaminants were sulphur dioxide, nitrogen dioxide, carbon monoxide, particulate matter, perfluorooctanoic acid, aluminum, iron, zinc, copper, titanium dioxide, silicates and endotoxins. We also identified different categories, 4 studies on the effects of air pollution, 3 on the intake of contaminated water, 3 on the effects of diet. Additionally, 2 studies evaluated the serum concentrations of contaminants, 1 studied the impact of exposure to house dust, 2 tried to characterize cells of patients with Inflammatory Bowel Disease and in one study colitis was induced. Overall, the quality of evidence is moderate to low, and there is inadequate evidence on the effect of environmental contaminants on Inflammatory Bowel Disease. Discussion: In this systematic review, we have identified different classes of environmental contaminants, but studies analyzing the concentration of environmental contaminants in biological matrices are rare. Given the different confounding factors that were not taken into account and the variability between studies it is difficult to draw conclusions on the real role of environmental contaminants on the onset of Inflammatory Bowel Disease or in flares. Conclusion: Based on a moderate to low level of quality, the available evidence gathered in this systematic review is insufficient to access the effects of environmental contaminants Inflammatory Bowel Disease. New epidemiological studies are necessary.