Emerging IBD demographics, phenotype and treatment in South Asia, South-East Asia and Middle East: Preliminary findings from the IBD-Emerging Nations' Consortium
Rupa Banerjee, Partha Pal , Ida Hilmi, Uday C Ghoshal, Devendra C Desai, M Masudur Rahman, Usha Dutta, Syed A Mohiuddin, Munnera Al Mohannadi, Mathew Philip, Ganesh N Ramesh, Madunil A Niriella, Arjuna P De Silva, H Janaka de Silva, Pises Pisespongsa , Julajak Limsrivilai , Satimai Aniwan, Metthananda Nawarathne , Nilesh Fernandopulle, Than Than Aye, Nwe Ni, Sameer Al Awadhi, Neeraj Joshi, Pham Thi V Ngoc , Tuan V Kieu, Anh Duong Nguyen, Murdani Abdullah, Ezzat Ali , Ahmed Zeid, Jose D Sollano , Bismillah Saberi, Mahmoud Omar, Mostafa Noor Mohsin , Hafeza Aftab , Tin Moe Wai , Yogesh M Shastri , Sujit Chaudhuri, Faruque Ahmed , Shobna J Bhatia , Simon P L Travis Published Feb 2022, in the Journal of gastroenterology and Hepatology.
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.