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

Banerjee R 1 , Pal P 1 , Hilmi I 2 , Ghoshal UC 3 , Desai DC 4 , Rahman MM 5 Show all authors , Dutta U 6 , Mohiuddin SA 7 , Al Mohannadi M 7 , Philip M 8 , Ramesh GN 9 , Niriella MA 10 , De Silva AP 10 , de Silva HJ 10 , Pisespongsa P 11 , Limsrivilai J 12 , Aniwan S 13 , Nawarathne M 14 , Fernandopulle N 14 , Aye TT 15 , Ni N 16 , Al Awadhi S 17 , Joshi N 18 , Ngoc PTV 19 , Kieu TV 19 , Nguyen AD 19 , Abdullah M 20 , Ali E 21 , Zeid A 21 , Sollano JD 22 , Saberi B 23 , Omar M 24 , Mohsin MN 25 , Aftab H 5 , Wai TM 26 , Shastri YM 27 , Chaudhuri S 28 , Ahmed F 5 , Bhatia SJ 29 , Travis SPL 30 , Inflammatory Bowel Disease-Emerging Nations' Consortium (IBD-ENC) study group

Affiliations 

  • 1 Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
  • 2 University of Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 3 Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
  • 4 Department of Gastroenterology, P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
  • 5 Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh
  • 6 Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
  • 7 Division of Gastroenterology, Department of Medicine, Hamad General Hospital, Doha, Qatar
  • 8 Lisie Institute of Gastroenterology, Lisie Hospital, Kochi, India
  • 9 Faculty of Medicine, Aster Hospital, Kochi, India
  • 10 Department of Medicine, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
  • 11 Digestive Disease Center, Bumrungrad Hospital, Bangkok, Thailand
  • 12 Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 13 King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • 14 Gastroenterology Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
  • 15 Department of Gastroenterology, Thingangyun General Hospital, University of Medicine 2, Yangon, Myanmar
  • 16 Department of Gastroenterology, Mandalay General Hospital and University of Medicine, Mandalay, Myanmar
  • 17 Digestive Disease Unit, Rashid Hospital, Dubai, United Arab Emirates
  • 18 Nidan Hospital, Kathmandu, Nepal
  • 19 Bach Mai National Hospital, Hanoi, Vietnam
  • 20 Department of Internal Medicine, Cipto Mangunkusumo National Hospital, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
  • 21 Department of Internal Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
  • 22 Department of Medicine, University of Santo Tomas, Manila, Philippines
  • 23 Amiri Medical Complex, Kabul, Afghanistan
  • 24 New Mowasat Hospital, Salmiya, Kuwait
  • 25 Department of Gastroenterology, Chittagong Medical College, Chittagong, Bangladesh
  • 26 Department of Gastroenterology, Yangon General Hospital, University of Medicine (1), Yangon, Myanmar
  • 27 Department of Gastroenterology, NMC Specialty Hospital, Abu Dhabi, United Arab Emirates
  • 28 AMRI Hospital-Salt Lake, Kolkata, India
  • 29 Sir H. N. Reliance Foundation Hospital, Mumbai, India
  • 30 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
J Gastroenterol Hepatol, 2022 Jun;37(6):1004-1015.
PMID: 35178742 DOI: 10.1111/jgh.15801

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.

CONCLUSIONS: The IBD-ENC cohort provides insight into IBD in South-East Asia and the Middle East, but is not yet population based. UC is twice as common as CD, familial disease is uncommon, and rates of surgery are low. Biologic use correlates with per capita GNI.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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