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. 2020 Nov 16;17(22):8495.
doi: 10.3390/ijerph17228495.

The Association between Drinking Water Quality and Inflammatory Bowel Disease-A Study in Eastern Croatia

Dubravka Holik  1 , Atila Bezdan  2 , Monika Marković  3 , Želimir Orkić  4 , Andrea Milostić-Srb  1 , Štefica Mikšić  1 , Aleksandar Včev  1
Affiliations

The Association between Drinking Water Quality and Inflammatory Bowel Disease-A Study in Eastern Croatia

Dubravka Holik et al. Int J Environ Res Public Health. .

Abstract

The incidence rate of inflammatory bowel disease (IBD) is becoming a global health problem that could be caused by changes in environmental and lifestyle habits. The study aimed to identify the association between the quality of drinking water, i.e., physiochemical and biological aspects of the phenotype and activity of IBD in Eastern Croatia. The study included 312 patients (63.4% ulcerative colitis, UC, and 36.6% Crohn's disease, CD) from the area of Eastern Croatia. The data were collected by questionnaires and the analysis of the water safety, based on 65 samples of drinking water by the patient's water supply method (public supply, rural water supply, and private well). IBD was active in 38.0% patients (34.0% CD and 40.0% UC). Significant differences (p = 0.001) were observed in the distribution of patients, according to counties in which they lived in. The largest deviation was noted in coliform bacteria, Escherichia coli, and enterococci bacteria, Fe, Al, and nitrate in rural water supply and private wells, although, without significant impact on IBD phenotype and activity. The hazard quotient (HQ) simulations showed that children are a sensitive group, regarding exposure to nitrates in drinking water over a long period of time, so there is a need for further monitoring and analysis of this issue.

Keywords: Crohn’s disease; Eastern Croatia; drinking water quality; inflammatory bowel disease; private wells; rural public supply; ulcerative colitis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The number of water samples according to the type of water supply in the study area.
Figure 2
Figure 2
Water analysis; Al (a); Enterococcus (b); coliform bacteria (c); Escherichia coli (d); Fe (e); nitrate (f) by counties.
Figure 2
Figure 2
Water analysis; Al (a); Enterococcus (b); coliform bacteria (c); Escherichia coli (d); Fe (e); nitrate (f) by counties.
Figure 3
Figure 3
The patient’s distribution according to the duration of water consumption.
Figure 4
Figure 4
The patient’s distribution according to the duration of water consumption.
See this image and copyright information in PMC

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