Current diagnosis and management of Crohn’s disease in China: results from a multicenter prospective disease registry

Abstract

Background This study aimed to understand the disease characteristics and treatment outcomes of Crohn’s disease (CD) in a real-world setting in China. Methods In this prospective, non-interventional, multicenter disease registry, adults (≥18 years) with existing and newly diagnosed CD were recruited from 14 medical centers across China from January 2015 to January 2017. The study consisted of the enrollment and follow-up periods, of 12 months each. Demographic, clinical characteristics, diagnostic duration and management of CD at enrollment were evaluated. Logistic regression analysis and stepwise multivariate logistic regression analysis used to assess the relationship between the risk factors and CD. Results Of 504 enrolled patients, 499 (99.0%) were eligible for analysis. The mean (SD) age at study enrollment was 32.3 (11.43) years and the majority (69.7%) of participants were male. In the past 15 years, a sustained decrease of the period of time in the diagnosis of CD was observed, at about 39.4 (24.11) months in 2010, which decreased to 3.1 (2.13) months in 2015. The most common presenting symptoms of CD included abdominal pain (78.0%), diarrhea (58.1%), weight loss (52.9%) and fever (30.1%). Oral ulcer (19.4%) and arthritis (9.8%) were the most common extra-intestinal manifestations. Non-stricturing non-penetrating (B1) (49.9%) behavior and ileocolonic involvement (L3) (56.2%) location were more frequent. Perianal disease was observed in 29.1% of the patients. Around 23.8% (119/499) patients had CD-related surgery other than perianal disease surgery. Older age at enrollment, longer disease course, complicated disease behavior and absence of perianal disease were all surgery risk factors ( p < 0.05). The most common medications was immunomodulators (e.g., azathioprine) (41.5%), anti-TNFα agents (32.9%) and aminosalicylates (20.6%). The mean (SD) Crohn’s Disease Active Index (CDAI) score was 159.1 (91.45) and almost half of the patients (49.1%, 81/165) were in remission. Conclusions This study demonstrated the CD-disease characteristics, risk factors of CD-related surgery and perianal disease, and treatment strategies in a real-world setting in China and may help in developing programs to diagnose and manage patients with CD. Electronic supplementary material The online version of this article (10.1186/s12876-019-1057-2) contains supplementary material, which is available to authorized users.

Temporal trend of disease recognition, treatment paradigm, and clinical outcomes of Crohn disease in Thailand from 2000 through 2017

“…The reported mean or median age at diagnosis in those studies was mostly within the range of 20 to 40 years. [ 3 , 6 , 9 , 12 – 14 , 16 , 20 , 22 , 25 , 27 , 28 , 30 , 34 , 40 , 41 , 44 , 48 – 50 ] There was no gender preference in our cohort, which is similar to many cohorts from Western countries, [ 3 , 20 , 31 , 35 , 41 ] but most cohorts from Asia reported male predominance at 60% to 70%. [ 6 , 9 , 13 , 15 , 22 , 27 , 28 , 30 , 34 , 44 , 48 , 49 ] The locations of disease at diagnosis in our cohort were L3 (40%), L1 (35%), and L2 (25%).…”

“…Although this duration is not nearly as long as the 3-year duration reported from India in 2009, [ 9 ] it is much longer than the median time to diagnosis of 3 months reported from Hong Kong and China in more recent years. [ 22 , 28 ] The median time to diagnosis in Europe was recently reported to be 4 months. [ 3 ] Furthermore, in contrast to the study from China that reported a dramatic decrease in the time to diagnosis from 79.4 months before 2010 to 3.1 months in 2015, [ 22 ] the diagnostic time in our study was stable between the before and after 2010 groups.…”

“…[ 22 , 28 ] The median time to diagnosis in Europe was recently reported to be 4 months. [ 3 ] Furthermore, in contrast to the study from China that reported a dramatic decrease in the time to diagnosis from 79.4 months before 2010 to 3.1 months in 2015, [ 22 ] the diagnostic time in our study was stable between the before and after 2010 groups. The reasons that we most suspect are physician unawareness of CD and/or physician difficulty differentiating CD from intestinal tuberculosis (ITB).…”

“…[ 26 , 29 ] Although some long-term CD cohorts from Asia have been reported, most of them are from East and South Asia. [ 7 , 9 , 16 , 22 , 28 , 34 , 44 , 47 , 48 ] Data from Southeast Asia remain scarce with only a few reports in the literature. [ 12 , 25 , 33 ] Our aim was to describe demographic and clinical characteristics, diagnostic proficiency, treatment pattern, and disease outcomes of CD in Thailand.…”

An analysis of histopathological features of Crohn’s disease in surgical specimens

“…However, although this set of diagnostic criteria plays an important role in CD diagnosis in surgically resected bowel specimens, its sensitivity and speci city have not been investigated. The incidence of CD has been steadily increasing in China in recent years [3]. Large-scale multicenter studies examining the diagnostic sensitivity and speci city are needed to validate the above diagnostic criteria.…”