Epidemiology of inflammatory bowel disease in South America: A systematic review

Abstract

BACKGROUNDThe worldwide epidemiology of inflammatory bowel disease (IBD) is rapidly changing. Increasing Crohn’s disease (CD) and ulcerative colitis (UC) incidence and prevalence have been recorded in developing regions such as Asia, Africa and Eastern Europe where it was previously thought to be uncommon. Whether this is also the case in South America is not well known. Demonstration that developing regions worldwide have increasing IBD incidence would indicate that environmental change plays a significant role in the development of IBD.AIMTo report the incidence, prevalence and disease characteristics of CD and UC within the South American continent.METHODSA systematic review was conducted by searching published studies in major international and regional databases (MEDLINE, EMBASE and Scopus) between January 1990 and December 2018. Outcomes considered were incidence, prevalence, phenotype, environmental and genetic factors, ethnicity and gender. A pair of independent reviewers screened and reviewed all identified articles.RESULTSOne hundred and sixty two citations were initially retrieved with 18 studies included in this systematic review. The majority of included studies were from Brazil (n =13, 72%). The incidence of UC ranged from 4.3-5.3/100000 person-years whilst the incidence of CD ranged from 0.74-3.5/100000 person-years. Prevalence ranged from 15.0-24.1/100000 inhabitants for UC and from 2.4-14.1/100000 inhabitants for CD. The incidence and prevalence of both UC and CD has increased significantly in Brazil over the past 21 years. Pancolitis was the most common disease distribution in patients with UC whilst colonic involvement was the most common distribution in CD. People residing in urban areas were at higher risk of developing both CD and UC.CONCLUSIONThe IBD burden in South America is increasing at a rate possibly even greater than other developing regions around the world. There is a paucity of high-quality epidemiological studies and further robust and representative data are required to further explore modifiable risk factors and disease phenotypes.

Review of the epidemiology and burden of ulcerative colitis in Latin America

“…In summary, consistent with other recent epidemiological reviews of IBD in Latin America, 5,6,8 we noted an increase in the incidence and prevalence of UC in this population. Furthermore, despite a considerable proportion of patients with UC in Latin America having moderate to severe disease and requiring surgery, advanced therapies for the treatment of UC were underutilised.…”

“…The public health system in Latin America faces a number of challenges, and health outcomes need to be improved by addressing the gaps in public health capacity. 49 In agreement with previous review articles, 6 – 8 additional high-quality standardised epidemiological studies are required to provide a clearer picture of the burden of UC in Latin America. This review may act as a starting point to better study UC epidemiology in a region that provides many opportunities for further local research.…”

“… 12 However, 2 recent reviews have reported that the incidence and prevalence of UC are increasing in Brazil. 6 , 8 …”

“… 7 Additionally, a recent systematic review of inflammatory bowel disease (IBD) in Latin America reported that the incidence of UC ranged from 4.3 to 5.3/100,000, and the prevalence of UC ranged from 15.0 to 24.1/100,000. 8 …”

A comparison of the efficacy and safety of complementary and alternative therapies for ulcerative colitis

“…[ 8 ] The prevalence of UC in urban population is relatively high. [ 9 ] So far, the pathogenesis of UC is not very clear, but it has been confirmed that genes, environment, intestinal microorganisms, and autoimmune factors are involved in the pathogenesis process of UC. [ 1 , 10 , 11 ] A prospective study [ 12 ] found that dietary factors are closely related to the onset of UC, and meat in the diet (especially red meat and processed meat, alcoholic beverages, and protein intake) is also associated with an increased likelihood of recurrence in UC patients.…”