Familial ulcerative colitis in Israeli Jews: Its prevalence and clinical severity compared to sporadic disease
Abstract Background & aim: A family history of inflammatory bowel disease (IBD) is present in some ulcerative colitis (UC) patients, but there is scant data on the impact of a familial component on the course of disease. We aimed to investigate the familial occurrence of UC and its impact on disease severity. Methods: A structured questionnaire was distributed to patients with UC at two tertiary university hospitals gastroenterology clinics. Respondents were inquired about background demographics, presence of family history of IBD and about various parameters of disease behavior. These parameters were compared for patients with or without positive family history of IBD Results: The study group consisted of 168 UC patients with a total of 952 1st degree relatives. Positive family history for IBD in a 1st degree relative was reported in 24 patients (14%). Six out of the 336 parents (1.8%) had IBD (all with UC). There were 13 siblings with IBD (4 CD, 9 UC) out of 249 (5.4%). Seven out of 376 (1.9%) off-springs had IBD (4 CD,3 UC). There was a trend for increased proportion of females among familial patients compared to sporadic cases (58% versus 40%, p=0.12). Familial patients have also reported significantly more disease exacerbations than the sporadic group (17.7±15 versus 6.8±11, respectively, p=0.006). On multi-variate analysis, familial disease was significantly and independently associated with both female sex (OR 4.1, 95% CI 1.1-14.9, p=0.04) and more exacerbations per year (annual OR 1.05, 95% CI 1.01-1.1, p=0.02). However, the increased rates of flares was likely related to mild exacerbations of disease since similar proportions of sporadic and familial patients were ever hospitalized, underwent colectomy or were treated by corticosteroids, immunomodulators and/or biologics. Conclusions: Familial occurrence of UC is not uncommon among Jewish patients in Israel. The familial-genetic component may influence preferentially disease occurrence among females, and is possibly associated with more disease flares although other parameters of disease severity do not seem to be impacted.