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Key Points Crohn's disease and ulcerative colitis are complex immunologically mediated diseases that arise due to a dysregulated immune response to commensal flora in a genetically susceptible host The incidence of IBD has traditionally been highest in North America and Western Europe with many cohorts suggesting a substantial secular increase over the second half of the twentieth century However, incidence of IBD is increasing in emerging populations such as Asia, suggesting that changing environmental factors play an important part Smoking and appendectomy were initially described to increase the risk of Crohn's disease and confer protection from ulcerative colitis

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