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Fulltext A four-decade analysis of the incidence trends, sociodemographic and clinical characteristics of inflammatory bowel disease patients at single tertiary centre, Kuala Lumpur, Malaysia

Mokhtar NM, Nawawi KNM, Verasingam J, Zhiqin W, Sagap I, Azman ZAM, et al.

BMC Public Health, 2019 Jun 13;19(Suppl 4):550.
PMID: 31196184 DOI: 10.1186/s12889-019-6858-2

BACKGROUND: Inflammatory bowel disease (IBD) was once considered as a Western disease. However, recent epidemiological data showed an emerging trend of IBD cases in the Eastern Asia countries. Clinico-epidemiological data of IBD in Malaysia is scarce. This study aimed to address this issue.
METHODS: Retrospective analysis of ulcerative colitis (UC) and Crohn's disease (CD), diagnosed from January 1980 till June 2018 was conducted at our centre.
RESULTS: A total of 413 IBD patients (281 UC, 132 CD) were identified. Mean crude incidence of IBD has increased steadily over the first three decades: 0.36 (1980-1989), 0.48 (1990-1999) and 0.63 per 100,000 person-years (2000-2009). In the 2010 to 2018 period, the mean crude incidence has doubled to 1.46 per 100,000 person-years. There was a significant rise in the incidence of CD, as depicted by reducing UC:CD ratio: 5:1 (1980-1989), 5:1 (1990-1999), 1.9:1 (2000-2009) and 1.7:1 (2010-2018). The prevalence rate of IBD, UC and CD, respectively were 23.0, 15.67 and 7.36 per 100,000 persons. Of all IBD patients, 61.5% (n = 254) were males. When stratified according to ethnic group, the highest prevalence of IBD was among the Indians: 73.4 per 100,000 persons, followed by Malays: 24.8 per 100,000 persons and Chinese: 14.6 per 100,000 persons. The mean age of diagnosis was 41.2 years for UC and 27.4 years for CD. Majority were non-smokers (UC: 76.9%, CD: 70.5%). The diseases were classified as follows: UC; proctitis (9.2%), left-sided colitis (50.2%) and extensive colitis (40.6%), CD; isolated ileal (22.7%), colonic (28.8%), ileocolonic (47.7%) and upper gastrointestinal (0.8%). 12.9% of CD patients had concurrent perianal disease. Extra intestinal manifestations were observed more in CD (53.8%) as compared to UC (12%). Dysplasia and malignancy, on the other hand, occurred more in UC (4.3%, n = 12) than in CD (0.8%, n = 1). Over one quarter (27.3%) of CD patients and 3.6% of UC patients received biologic therapy.
CONCLUSION: The incidence of IBD is rising in Malaysia, especially in the last one decade. This might be associated with the urbanization and changing diets. Public and clinicians' awareness of this emerging disease in Malaysia is important for the timely detection and management.

Matched MeSH terms: Inflammatory Bowel Diseases/epidemiology*
Fulltext Prevalence of colorectal cancer associated with Streptococcus bovis among inflammatory bowel and chronic gastrointestinal tract disease patients

Al-Jashamy K, Murad A, Zeehaida M, Rohaini M, Hasnan J

Asian Pac J Cancer Prev, 2010;11(6):1765-8.
PMID: 21338230

Colorectal cancer (CRC) is the second most common cause of cancer mortality among men and women worldwide; the risk of its occurrence has been shown to be increased by chronic bacterial infections. A case control study was therefore carried out at Hospital Universiti Sains Malaysia (HUSM) to determine the incidence of colorectal cancer associated with S. bovis infection. A total of 166 stool specimens were collected from diseased patients and healthy individuals and S. bovis isolates were identified. Suspected colon tumor and cancer cases were diagnosed and confirmed. It was found that overall prevalence of S. bovis was 41 (24.7%) out of 166 cases studied. Some 41(48.6%) of these S. bovis isolates was found in patients with colonic polyps, adenocarcinomas, inflammatory bowel disease (IBD) and chronic gastrointestinal tract (GIT). It was also found that colorectal cancer incidence was 24.7%, adenocarinomas accounting for 51% with the highest incidence in the sigmoid part of the colon. Among the IBD and chronic GIT cases, ulcerative colitis featured in the majority of cases (41.4%). In conclusion, there is a high incidence of colorectal cancer associated with S. bovis.

Matched MeSH terms: Inflammatory Bowel Diseases/complications*; Inflammatory Bowel Diseases/microbiology; Inflammatory Bowel Diseases/epidemiology
Radiation Exposure in Patients with Inflammatory Bowel Disease: a Fourteen-Year Review at a Tertiary Care Centre in Malaysia

Naidu J, Wong Zh, Palaniappan Sh, Ngiu ChS, Yaacob NY, Abdul Hamid H, et al.

Asian Pac J Cancer Prev, 2017 04 01;18(4):933-939.
PMID: 28545190

Background and Aims: Patients with inflammatory bowel disease (IBD) are subjected to a large amount of ionizing
radiation during the course of their illness. This may increase their risk of malignancy to a greater level than that due
to the disease itself. In Caucasian patients with Crohn’s disease, this has been well documented and recommendations
are in place to avoid high radiation imaging protocols. However, there are limited data available on radiation exposure
in Asian IBD patients.We therefore sought to identify total radiation exposure and any differences between ethnically
diverse ulcerative colitis (UC) and Crohn’s disease (CD) patients at our centre along with determining factors that may
contribute to any variation. Methods: The cumulative effective dose (CED) was calculated retrospectively from 2000
to 2014 using data from our online radiology database and patients’ medical records. Total CED in the IBD population
was measured. High exposure was defined as a radiation dose of greater than 0.2mSv (equivalent to slightly less than
½ a year of background radiation). Results: A total of 112 cases of IBD (36 CD and 76 UC) were reviewed. Our CD
patients were diagnosed at an earlier age than our UC cases (mean age 26.1 vs 45.7). The total CED in our IBD population
was 8.53 (95% CI: 4.53-12.52). Patients with CD were exposed to significantly higher radiation compared to those
with UC. The mean CED was 18.6 (7.30-29.87) and 3.65 (1.74-5.56, p=0.01) for CD and UC patients respectively. 2
patients were diagnosed as having a malignancy during follow up with respective CED values of 1.76mSv and 10mSv.
Conclusions: CD patients, particularly those with complicated disease, received a higher frequency of diagnostic
imaging over a shorter period when compared to UC patients. Usage of low radiation imaging protocols should be
encouraged in IBD patients to reduce their risk of consequent malignancy.

Matched MeSH terms: Inflammatory Bowel Diseases
Comparative Efficacy of Chitosan, Pectin Based Mesalamine Colon Targeted Drug Delivery Systems on TNBS-induced IBD Model Rats

Newton AMJ, Lakshmanan P

Antiinflamm Antiallergy Agents Med Chem, 2020;19(2):113-127.
PMID: 30657050 DOI: 10.2174/1871523018666190118112230

OBJECTIVE: A number of natural polymer-based drug delivery systems targeting the colon are reported for different applications. Most of the research is based on the class of natural polymers such as polysaccharides. This study compares the anti-inflammatory effect of different polysaccharide based tablets on IBD when a drug carrier is targeted to the colon as matrix and coated systems.
METHODS: The TNBS induced IBD Wistar rats were used as a model for the study. The microscopic and macroscopic parameters were studied in detail. Almost all the important IBD parameters were reported in this work.
RESULTS: The results demonstrated that the polysaccharides are efficient in carrying the drugs to the colon. Reduction in the level of ulcer index (UI), Myeloperoxidase (MPO), and Malondialdehyde MDA, confirmed the inhibitory activity on the development of Reactive oxygen species (ROS). The increased level of Tumor necrosis factor (TNFα) an expression of colonic inducible nitric oxide synthase (iNOS) was lowered in treatments as compared to TNBS control.
CONCLUSION: The different polymer-based mesalamine (DPBM) confirmed the efficient anti- inflammatory activity on IBD induced rats. The increased level of glutathione (GSH), and superoxide dismutase (SOD) also confirmed the effective anti-inflammatory effect. A significant decrease in the ulcer score and ulcer area was reported. The investigation revealed that chitosan is superior to pectin in IBD treatment likewise polysaccharide-based matrix systems are superior to the coated system.

Matched MeSH terms: Inflammatory Bowel Diseases/drug therapy*
Fulltext The relationship between inflammatory bowel disease and Helicobacter pylori across East Asian, European and Mediterranean countries: a meta-analysis

Imawana RA, Smith DR, Goodson ML

Ann Gastroenterol, 2020 06 06;33(5):485-494.
PMID: 32879595 DOI: 10.20524/aog.2020.0507

Background: The current literature suggests a protective benefit of Helicobacter pylori (H. pylori) infection against inflammatory bowel disease (IBD). Here we assessed whether this effect varied by IBD subtype-Crohn's disease (CD) or ulcerative colitis (UC)-and geographic region: East Asia, Europe (non-Mediterranean) or Mediterranean region.
Methods: A database search was performed up to July 2019 inclusive for all studies that compared H. pylori infection in IBD patients vs. non-IBD controls. The relative risk (RR) was used to quantify the association between IBD and H. pylori, and the effects were combined across studies using a mixed-effects meta-regression model, which included IBD subtype and geographic region as categorical moderator variables.
Results: Our meta-regression model exhibited moderate heterogeneity (I2=48.74%). Pooled RR depended on both region (P=0.02) and subtype (P<0.001). Pooled RRs were <1 for all subtype and region combinations, indicative of a protective effect of H. pylori against IBD. The pooled RR was 28% (9%, 50%; P=0.001) greater for UC vs. CD and 43% (4%, 96%; P=0.02) greater for Mediterranean countries vs. East Asia. The pooled RR was 18% (-13%, 60%; P=0.48) greater for Europe vs. East Asia and 21% (-13%, 68%; P=0.42) greater for Mediterranean vs. Europe, though these differences were not statistically significant.
Conclusions: The protective effect of H. pylori on IBD varied by both subtype (more protection against CD vs. UC) and region (East Asia more protected than Mediterranean regions). Variation due to these effects could provide insight into IBD etiology.

Matched MeSH terms: Inflammatory Bowel Diseases