How Does the Epidemiology of Inflammatory Bowel Disease Differ between East and West? A Korean Perspective

Abstract

Background: Though low compared with those in Western countries, the incidence and prevalence of inflammatory bowel disease (IBD) are rapidly increasing in Asia. If we could understand the differences in IBD epidemiology between Asian and Western countries, we might gain insights into the etiopathogenesis of IBD as well as guidance for personalized therapy. Summary: In Asia, unlike in the West, Crohn's disease (CD) predominantly occurs in men and involves a high prevalence of perianal fistulas. Moreover, in Korean CD patients, ileocolonic involvement is predominant, whereas isolated colonic involvement is very uncommon. In both ulcerative colitis (UC) and CD, extraintestinal manifestations, such as primary sclerosing cholangitis, as well as a positive family history of IBD are less frequent in Asian patients. However, as the prevalence of IBD rises in Korea, so does the frequency of a positive family history. While the colectomy rate among Korean UC patients is lower, the intestinal resection rate in CD patients is similar in Korea and in the West. Infectious problems that can adversely influence IBD management are usually more common in Asia. Key Messages: IBD in Asians differs from that in Westerners in many aspects, including demographic and clinical characteristics, prognosis, and associated problems.

Long-term prognosis of ulcerative colitis and its temporal changes between 1986 and 2015 in a population-based cohort in the Songpa-Kangdong district of Seoul, Korea

“…Lastly, we did not obtain detailed information regarding extraintestinal manifestations (EIMs) in these patients. The frequency of EIMs in IBD was lower in East Asia than in Western countries 39. However, a reliable assessment of the frequency of EIMs is difficult because many of them are non-specific or transient.…”

The Coming of Age of Inflammatory Bowel Diseases in Asia

“…In the present issue of the journal, Yang [1] and Kedia and Ahuja [2] revisit this subject in light of recent acquisitions in the field and their own outstanding contributions. Yang [1] highlights a number of differences in Korean patients compared to their Western counterparts, including the greater prevalence of CD in males, the Western countries acquire the risk of the baseline population [4] .…”

“…greater prevalence of perianal disease and infectious complications in CD, as well as a lower prevalence of extraintestinal manifestations and positive family history of IBD [1] . IBD natural history, response to biologic therapy, and disease evolution over time appear similar to those reported in the West.…”

“…Yang [1] highlights a number of differences in Korean patients compared to their Western counterparts, including the greater prevalence of CD in males, the Western countries acquire the risk of the baseline population [4] . In general, current data, including those presented by Yang [1] and Kedia and Ahuja [2] , do suggest a close similarity between patients diagnosed with IBD in Asia and those diagnosed in the Western world, with few notable differences. A final answer might take a long time to come.…”

“…We do not have an answer to the latter question. What we know -as stressed by both Yang [1] and Kedia and Ahuja [2] -is that the total IBD burden in Asia will likely surpass in the near future that in Western countries, which are already struggling to deal with these life-long, debilitating and extremely expensive diseases. Hence, Asian countries should leverage on the Western experience and be prepared to handle an epidemic of massive proportions in a very short time.…”