Emerging inflammatory bowel disease demographics, phenotype, and treatment in South Asia, South‐East Asia, and Middle East: Preliminary findings from the Inflammatory Bowel Disease‐Emerging Nations' Consortium

Abstract

Background and Aim: Inflammatory bowel disease (IBD) is emerging in the newly industrialized countries of South Asia, South-East Asia, and the Middle East, yet epidemiological data are scarce. Methods: We performed a cross-sectional study of IBD demographics, disease phenotype, and treatment across 38 centers in 15 countries of South Asia, South-East Asia, and Middle East. Intergroup comparisons included gross national income (GNI) per capita. Results: Among 10 400 patients, ulcerative colitis (UC) was twice as common as Crohn's disease (CD), with a male predominance (UC 6678, CD 3495, IBD unclassified 227, and 58% male). Peak age of onset was in the third decade, with a low proportion of elderly-onset IBD (5% age > 60). Familial IBD was rare (5%). The extent of UC was predominantly distal (proctitis/left sided 67%), with most being treated with mesalamine (94%), steroids (54%), or immunomodulators (31%). Ileocolic CD (43%) was the commonest, with low rates of perianal disease (8%) and only 6% smokers. Diagnostic delay for CD was common (median 12 months; interquartile range 5-30). Treatment of CD included mesalamine, steroids, and immunomodulators (61%, 51%, and 56%, respectively), but a fifth received empirical antitubercular therapy. Treatment with biologics was uncommon (4% UC and 13% CD), which increased in countries with higher GNI per capita. Surgery rates were 0.1 (UC) and 2 (CD) per 100 patients per year.

The epidemiology of inflammatory bowel disease in Asia and Asian immigrants to Western countries

“…Inflammatory (B1), stricturing (B2), and penetrating (B3) CD phenotypes were reported in 70%, 16%, and 14% of patients, respectively. Perianal CD was seen in about 16%–18% of CD patients 22,29 . These data were concordant with population‐based European and Asian cohorts: 66%–75% had an inflammatory type, 10%–21% had stricturing (B2), and 8%–17% had penetrating (B3) lesions 4,16,33 .…”

“…One‐third of patients with CD had complex disease behavior (i.e., stricturing or penetrating disease). The proportions of patients with inflammatory, stricturing, and penetrating phenotypes and perianal disease were 63%, 23%, 13%, and 12.5%, respectively 22 . Both UC and CD characteristics of South‐Asian patients were similar to those of patients in Southeast Asia 16 .…”

“…First‐degree relatives with IBD were found in 2%–3% of IBD patients in India, Bangladesh, Nepal, and Sri Lanka. Overall, the South‐Asia (5%) and Southeast Asia (2%) had fewer patients with a family history of IBD than the Middle East (17%) 22 …”

Perforated ileum as the initial presentation of Crohn's disease, a case report

“…It is accepted that Western and Eastern phenotypes do differ: with patients from Eastern populations leaning towards a male predominance, ileocolic disease, and a lower association with cigarette smoking, familial aggregation, and extra-intestinal disease compared to Western populations [5] .…”

“…Postoperative therapy with an anti-TNF agent reduces the risk of both clinical and endoscopic recurrence (OR 0.51, 95 % CI 0.28–0.94, and OR 0.24, 95 % CI 0.15–0.39, respectively) [5] .…”