Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn's and colitis epidemiology study

Ng SC 1 , Tang W 2 , Ching JY 2 , Wong M 2 , Chow CM 3 , Hui AJ 4 Show all authors , Wong TC 5 , Leung VK 6 , Tsang SW 7 , Yu HH 8 , Li MF 8 , Ng KK 9 , Kamm MA 10 , Studd C 10 , Bell S 10 , Leong R 11 , de Silva HJ 12 , Kasturiratne A 12 , Mufeena MNF 12 , Ling KL 13 , Ooi CJ 13 , Tan PS 14 , Ong D 14 , Goh KL 15 , Hilmi I 15 , Pisespongsa P 16 , Manatsathit S 17 , Rerknimitr R 18 , Aniwan S 18 , Wang YF 19 , Ouyang Q 19 , Zeng Z 20 , Zhu Z 20 , Chen MH 20 , Hu PJ 20 , Wu K 21 , Wang X 21 , Simadibrata M 22 , Abdullah M 22 , Wu JC 2 , Sung JJY 2 , Chan FKL 2 , Asia–Pacific Crohn's and Colitis Epidemiologic Study (ACCESS) Study Group

Affiliations 

  • 1 Institute of Digestive Disease, Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China. Electronic address: siewchienng@cuhk.edu.hk
  • 2 Institute of Digestive Disease, Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
  • 3 Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, China
  • 4 Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
  • 5 North District Hospital, Hong Kong, China
  • 6 United Christian Hospital, Hong Kong, China
  • 7 Tseung Kwan O Hospital, Hong Kong, China
  • 8 Kiangwu Hospital, Macau, China
  • 9 Hospital Conde S Januario, Macau, China
  • 10 St Vincent's Hospital and University of Melbourne, Melbourne, Australia
  • 11 Bankstown and Concord Hospitals, Sydney, Australia
  • 12 Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
  • 13 Singapore General Hospital, Singapore
  • 14 National University Hospital of Singapore, Singapore
  • 15 University of Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 16 Maharaj Nakorn Chiangmai Hospital, Chiangmai, Thailand
  • 17 Siriraj Hosptial, Bangkok, Thailand
  • 18 King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • 19 West China Hospital, Sichuan University, Chengdu, China
  • 20 The First Affiliated Hospital of San Yat Sen University, Guangzhou, China
  • 21 Department of Gastroenterology, Xijing Hospital, Fourth Military Medical University, Shaanxi, China
  • 22 University of Indonesia, Depok, Indonesia
Gastroenterology, 2013 Jul;145(1):158-165.e2.
PMID: 23583432 DOI: 10.1053/j.gastro.2013.04.007

Abstract

BACKGROUND & AIMS: Inflammatory bowel diseases (IBD) are becoming more common in Asia, but epidemiologic data are lacking. The Asia-Pacific Crohn's and Colitis Epidemiology Study aimed to determine the incidence and phenotype of IBD in 8 countries across Asia and in Australia.

METHODS: We performed a prospective, population-based study of IBD incidence in predefined catchment areas, collecting data for 1 year, starting on April 1, 2011. New cases were ascertained from multiple overlapping sources and entered into a Web-based database. Cases were confirmed using standard criteria. Local endoscopy, pathology, and pharmacy records were searched to ensure completeness of case capture.

RESULTS: We identified 419 new cases of IBD (232 of ulcerative colitis [UC], 166 of Crohn's disease [CD], and 21 IBD-undetermined). The crude annual overall incidence values per 100,000 individuals were 1.37 for IBD in Asia (95% confidence interval: 1.25-1.51; 0.76 for UC, 0.54 for CD, and 0.07 for IBD-undetermined) and 23.67 in Australia (95% confidence interval: 18.46-29.85; 7.33 for UC, 14.00 for CD, and 2.33 for IBD-undetermined). China had the highest incidence of IBD in Asia (3.44 per 100,000 individuals). The ratios of UC to CD were 2.0 in Asia and 0.5 in Australia. Median time from symptom onset to diagnosis was 5.5 months (interquartile range, 1.4-15 months). Complicated CD (stricturing, penetrating, or perianal disease) was more common in Asia than Australia (52% vs 24%; P = .001), and a family history of IBD was less common in Asia (3% vs 17%; P < .001).

CONCLUSIONS: We performed a large-scale population-based study and found that although the incidence of IBD varies throughout Asia, it is still lower than in the West. IBD can be as severe or more severe in Asia than in the West. The emergence of IBD in Asia will result in the need for specific health care resources, and offers a unique opportunity to study etiologic factors in developing nations.

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

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