Elsevier

The Journal of Pediatrics

Volume 155, Issue 3, September 2009, Pages 421-426
The Journal of Pediatrics

Original Article
Systematic Review: The Role of Breastfeeding in the Development of Pediatric Inflammatory Bowel Disease

https://doi.org/10.1016/j.jpeds.2009.03.017Get rights and content

Objectives

To assess the current evidence for the role of breastfeeding in the development of early onset inflammatory bowel disease (IBD) with a systematic review.

Study design

An electronic database search was performed (January 1966-January 2008) with keywords related to IBD and breastfeeding, looking specifically for studies that reported outcome in early-onset disease (<16 years of age) and ā€œany exposureā€ to breast milk as the variables. Meta-analysis of studies included for review was then performed by using a random effects model, and results were expressed as odds ratios (OR) with 95% CIs.

Results

A total of 79 articles were identified, 20 of which were found describing breastfeeding in relation to the development of IBD; 8 of these articles included separate early-onset groups. One study did not describe ā€œany exposureā€ to breast milk for the early onset group, so 7 studies were included in the meta-analysis. Breast milk exposure had a significant protective effect (OR, 0.69; 95% CI, 0.51-0.94; P = .02) in developing early-onset IBD. A non-significant difference was demonstrated for ulcerative colitis and Crohn's disease individually (OR, 0.72; 95% CI, 0.51-1.02; P = .06; OR, 0.64; 95% CI, 0.38-1.07; P = .09, respectively).

Conclusions

The current evidence demonstrates a possible protective effect for breast milk in the development of early onset IBD. However, the quality of existing data is generally poor. These findings need to be investigated in well-designed prospective studies.

Section snippets

Methods

A literature search was undertaken to answer the question, ā€œWhat is the role of breastfeeding in the development of early onset IBD?ā€ The search used an explicit search strategy with the key words ā€œbreastfeeding,ā€ ā€œinflammatory bowel disease,ā€ ā€œCrohn's disease,ā€ and ā€œulcerative colitisā€(the full search strategy is available from the authors on request). The search was carried out in the Ovid databases Medline (1966-January 2008), Old Medline 1951-1965, Cochrane Library (1991- first quarter

Results

The database combination searches and abstract review retrieved 72 potentially relevant articles. Seven more articles were identified from the reference lists of the aforementioned articles and with a specific hand search. After reviewing all these articles in full, 59 were excluded because they did not present original data on breastfeeding and outcomes in IBD. Therefore, a total of 20 relevant articles related to the search question remained.24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36,

Discussion

The current evidence shows that breast milk exposure may be associated with a lower development of early-onset IBD. A previously published meta-analysis of the effects of breastfeeding on all age of onset IBD has suggested a protective modifying role, particularly for CD.32 However, this review used a non-validated method to appraise the quality of evidence described in these studies.32 The SIGN methodology used in this study has been proven to be a valid and rigorous method of appraisal of the

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    The authors declare no conflicts of interest.

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