Inflammatory Bowel Disease

Subject Category: Inflammatory Bowel Disease

Am J Gastroenterol 2013; 108:1480–1485; doi:10.1038/ajg.2013.186; published online 13 August 2013

Heat Waves, Incidence of Infectious Gastroenteritis, and Relapse Rates of Inflammatory Bowel Disease: A Retrospective Controlled Observational Study

Christine N Manser MD1, Michaela Paul PhD2, Gerhard Rogler MD, PhD1, Leonhard Held PhD2,4 and Thomas Frei PhD3,4

  1. 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital, Zurich, Switzerland
  2. 2Division of Biostatistics, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
  3. 3Federal Department of Home Affairs, Federal Office of Meteorology and Climatology, Zurich, Switzerland
  4. 4These authors contributed equally to this work

Correspondence: Thomas Frei, PhD, Federal Department of Home Affairs, Federal Office of Meteorology and Climatology, Krähbühlstr. 58, CH-8044 Zurich, Switzerland. E-mail:

Received 9 October 2012; Accepted 7 May 2013
Advance online publication 13 August 2013





The objective of this study was to evaluate the effect of heat waves on flares of inflammatory bowel disease (IBD) and infectious gastroenteritis (IG).



In this retrospective controlled observational study, data from 738 IBD and 786 IG patients admitted to the University Hospital of Zurich in the years 2001–2005, as well as from 506 other noninfectious chronic intestinal inflammations, which were used as control, were collected. Climate data were obtained from the Swiss Federal Office for Meteorology and Climatology.



The presence of a heat wave increased the risk of IBD flares by 4.6% (95% confidence interval (CI): 1.6–7.4%, P=0.0035) and of IG flares by 4.7% (95% CI: 1.8–7.4%, P=0.0020) for every additional day within a heat wave period. In the control group there was no significant effect (95% CI: −6.2–2.9%, P=0.53). Screening of alternative forms for the effect of heat waves suggested that for IG the effect is strongest when lagged by 7 days (risk increase per day: 7.2%, 95% CI: 4.6–9.7%, P<0.0001), whereas for IBD no such transformation was required. Other formulations with additive effects, interactions between heat waves and time of the year, and additional adjustments for daily average temperature did not show any improvement in model fit.



In this retrospective controlled observational study, we found a substantial increase in hospital admissions because of flares of IBD and IG during heat wave periods. Whereas the effect on IG is strongest with a delay of 7 days, the effect on IBD flares is immediate, suggesting different mechanisms.