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Hormone Therapy raises Risk of Ulcerative Colitis but not Crohn's Disease

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By Jimmy Downs
Friday Sept 28, 2012 (foodconsumer.org) -- Hormone replacement therapy or simply hormone therapy increases risk of ulcerative colitis (UC), but not risk of Crohn's Disease (CD), according to a study recently published in the journal Gastroenterology.  Early studies have associated hormone replacement therapy with increased risk for heart disease and breast cancer.

Hamed Khalili of Department of Adult Oncology, Dana-Farber Cancer Institute in Boston, Massachusetts and colleagues conducted the study and found women who ever used hormone therapy were at least 65 percent more likely to develop ulcerative colitis, compared with those who never used it.

The researchers found the association after analysing data from 108,844 postmenopausal US women at the median age of 54 years enrolled in 1976 in the Nurses' Health Study without a prior history of Crohn's disease (CD) and ulcerativecolitis (UC).

For the study, participants were surveyed every 2 years for information on menopause status, postmenopausal hormone replacement therapy and other potential risk factors and self-reported diagnoses of these diseases which were subject to a review by two gastroenterologists.   During more than 1.8 million person-years of follow-up from the start of the study through 2008, 138 incident cases of Crohn's disease and 138 cases of ulcerative colitis were identified.

The researchers found that compared with those who never used hormones, those who currently used hormone therapy were 71 percent more likely to be diagnosed with ulcerative colitis and among past users, the risk was increased by 65 percent.  The association seemed to be dose-responsive, that is, a longer period of use was linked to a higher risk for the disease. But the risk decreased with time after discontinuation of the treatment.

Both estrogen based and estrogen plus progestin based hormone therapy were associated with the same magnitude of risk for ulcerative colitis.   And the increase in risk of ulcerative colitis by hormone therapy was not affected by age, body mass index and smoking status.

On the other hand, no significant association was observed between hormone therapy and risk of Crohn's disease.

"In a large prospective cohort of women, postmenopausal hormone therapy was associated with an increased risk of UC but not CD. These findings indicate that pathways related to estrogens might mediate the pathogenesis of UC," the researchers concluded.

The researchers say in their report "estrogen has been proposed to modulate gut inflammation through an effect on estrogen receptors found on gastrointestinal epithelial and immune cells."

Ulcerative colitis is an inflammatory bowel disease that affects the lining of the large intestine (colon) and rectum.  This disease when left untreated can increase risk of a wide spectrum of diseases or medical conditions, including ankylosing spondylitis, blood clots, colorectal cancer, colon narrowing, impaired growth and sexual development in children, arthritis, liver disease, massive bleeding in the colon, mouth ulcers, skin ulcer, sores in the eye and tears or holes in the colon.

The disease has no cure, but with prescription drugs, the condition can be managed.  According to Pubmed Health, certain foods can worsen symptoms of ulcerative colitis.  Patients are advised to eat small portions of food throughout the day, drink water frequently, avoid high fiver foods like bran, beans, nuts, seeds and popcorn, aboid, fatty, greasy or fried foods and sauces, limit consumption of  milk products.

Recent studies have suggested that vitamin D deficiency are common in patients with ulcerative colitis, suggesting that taking vitamin D supplement may help prevent or treat the disease.

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