Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2020; 26(37): 5661-5672
Published online Oct 7, 2020. doi: 10.3748/wjg.v26.i37.5661
Periodontitis combined with smoking increases risk of the ulcerative colitis: A national cohort study
Eun Ae Kang, Jaeyoung Chun, Jee Hyun Kim, Kyungdo Han, Hosim Soh, Seona Park, Seung Wook Hong, Jung Min Moon, Jooyoung Lee, Hyun Jung Lee, Jun-Beom Park, Jong Pil Im, Joo Sung Kim
Eun Ae Kang, Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, South Korea
Jaeyoung Chun, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06229, South Korea
Jee Hyun Kim, Department of Internal Medicine, Bundang CHA Medical Center, CHA University School of Medicine, Seoul 13496, South Korea
Kyungdo Han, Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, South Korea
Hosim Soh, Seona Park, Seung Wook Hong, Jung Min Moon, Jooyoung Lee, Hyun Jung Lee, Jong Pil Im, Joo Sung Kim, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea
Jun-Beom Park, Department of Periodontics, the Catholic University of Korea College of Medicine, Seoul 06591, South Korea
Author contributions: Kang EA, Chun J, Kim JH and Han K completed the conception and design of the study; Kim JH, Han K, Soh H, Park S, Hong SW, Moon JM and Lee J completed the acquisition, analysis and interpretation of data; Kang EA and Chun J drafted and revised the article; Kang EA, Chun J, Lee HJ, Park JB, Im JP and Kim JS completed the final approval of the article submitted.
Institutional review board statement: The study was approved by the Institutional Review Board of the University of Seoul National University Hospital, No. H-1703-107-840.
Informed consent statement: The subjects’ information in the database was de-identified before the investigator accessed the data, thus informed consent was waived.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Data sharing statement: No additional data are available
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jaeyoung Chun, MD, Assistant Professor, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Yeonju-ro 63-gil, Gangnam-gu, Seoul 06229, South Korea. chunjmd@yuhs.ac
Received: May 18, 2020
Peer-review started: May 18, 2020
First decision: July 29, 2020
Revised: August 7, 2020
Accepted: September 16, 2020
Article in press: September 16, 2020
Published online: October 7, 2020
Abstract
BACKGROUND

Periodontitis is a chronic inflammation of periodontal tissues. The effect of periodontitis on the development of inflammatory bowel disease (IBD) remains unclear.

AIM

To assessed the risk of IBD among patients with periodontitis, and the risk factors for IBD related to periodontitis.

METHODS

A nationwide population-based cohort study was performed using claims data from the Korean National Healthcare Insurance Service. In total, 9950548 individuals aged ≥ 20 years who underwent national health screening in 2009 were included. Newly diagnosed IBD [Crohn’s disease (CD), ulcerative colitis (UC)] using the International Classification of Disease 10th revision and rare intractable disease codes, was compared between the periodontitis and non-periodontitis groups until 2017.

RESULTS

A total of 1092825 individuals (11.0%) had periodontitis. Periodontitis was significantly associated with older age, male gender, higher body mass index, quitting smoking, not drinking alcohol, and regular exercise. The mean age was 51.4 ± 12.9 years in the periodontitis group and 46.6 ± 14.2 years in the non-periodontitis group (P < 0.01), respectively. The mean body mass index was 23.9 ± 3.1 and 23.7 ± 3.2 in the periodontitis and non-periodontitis groups, respectively (P < 0.01). Men were 604307 (55.3%) and 4844383 (54.7%) in the periodontitis and non-periodontitis groups, respectively. The mean follow-up duration was 7.26 years. Individuals with periodontitis had a significantly higher risk of UC than those without periodontitis [adjusted hazard ratio: 1.091; 95% confidence interval (CI): 1.008-1.182], but not CD (adjusted hazard ratio: 0.879; 95% confidence interval: 0.731-1.057). The risks for UC were significant in the subgroups of age ≥ 65 years, male gender, alcohol drinker, current smoker, and reduced physical activity. Current smokers aged ≥ 65 years with periodontitis were at a 1.9-fold increased risk of UC than non-smokers aged ≥ 65 years without periodontitis.

CONCLUSION

Periodontitis was significantly associated with the risk of developing UC, but not CD, particularly in current smokers aged ≥ 65 years.

Keywords: Inflammatory bowel disease, Periodontitis, Smoking, Ulcerative colitis, Crohn’s disease

Core Tip: We evaluate the impact of periodontitis on the development of ulcerative colitis (UC) using the nationwide population-based cohort data. In total, 9950548 individuals undergoing national health screenings in 2009 were included in this study and were followed for an average of 7.26 years. Patients with periodontitis had a higher risk of UC than those without periodontitis. Current smokers over 65 years with periodontitis were at a 1.9-fold increased risk of UC than non-smokers without periodontitis. Periodontitis was significantly associated with the risk of UC and cigarette smoking could superimpose the impact of periodontitis on UC, especially in elderly people.