Early Course of Inflammatory Bowel Disease in a Population-Based Inception Cohort Study From 8 Countries in Asia and Australia.


BACKGROUND & AIMS The incidence of inflammatory bowel disease (IBD) is increasing in Asia, but little is known about disease progression in this region. The Asia-Pacific Crohn's and Colitis Epidemiology Study was initiated in 2011, enrolling subjects from 8 countries in Asia (China, Hong Kong, Indonesia, Sri Lanka, Macau, Malaysia, Singapore, and Thailand) and Australia. We present data from this ongoing study. METHODS We collected data on 413 patients diagnosed with IBD (222 with ulcerative colitis [UC], 181 with Crohn's disease [CD], 10 with IBD unclassified; median age, 37 y) from 2011 through 2013. We analyzed the disease course and severity and mortality. Risks for medical and surgical therapies were assessed using Kaplan-Meier analysis. RESULTS The cumulative probability that CD would change from inflammatory to stricturing or penetrating disease was 19.6%. The cumulative probabilities for use of immunosuppressants or anti-tumor necrosis factor agents were 58.9% and 12.0% for patients with CD, and 12.7% and 0.9% for patients with UC, respectively. Perianal CD was associated with an increased risk of anti-tumor necrosis factor therapy within 1 year of its diagnosis (hazard ratio, 2.97; 95% confidence interval, 1.09-8.09). The cumulative probabilities for surgery 1 year after diagnosis were 9.1% for patients with CD and 0.9% for patients with UC. Patients with CD and penetrating disease had a 7-fold increase for risk of surgery, compared with patients with inflammatory disease (hazard ratio, 7.67; 95% confidence interval, 3.93-14.96). The overall mortality for patients with IBD was 0.7%. CONCLUSIONS In a prospective population-based study, we found that the early course of disease in patients with IBD in Asia was comparable with that of the West. Patients with CD frequently progress to complicated disease and have accelerated use of immunosuppressants. Few patients with early stage UC undergo surgery in Asia. Increasing our understanding of IBD progression in different populations can help optimize therapy and improve outcomes.

DOI: 10.1053/j.gastro.2015.09.005

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@article{Ng2016EarlyCO, title={Early Course of Inflammatory Bowel Disease in a Population-Based Inception Cohort Study From 8 Countries in Asia and Australia.}, author={S C Ng and Zhirong Zeng and O Niewiadomski and Whitney Tang and Sally J Bell and M. Kamm and Pinjin Hu and Hithanadura Janaka de Silva and Madunil A Niriella and W S A A Yasith Udara and David Eng Hui Ong and Khoon Lin Ling and Choon Jin Ooi and Ida Hilmi and Khean Lee Goh and Qin Ouyang and Yu Wang and Kaichun Wu and Xin Wang and Pises Pisespongsa and Sathaporn Manatsathit and Satimai Aniwan and Julajak Limsrivilai and Jeffri Gunawan and Marcellus Simadibrata and Murdani Abdullah and Steve Tsang and Fu Hang Lo and Aric J Hui and Chung Mo Chow and Hon Ho Yu and Mo Fong Li and Ka Kei Ng and Jessica Y. L. Ching and Victor W. C. Chan and Justin C. Y. Wu and Francis K L Chan and Min-hu Chen and Joseph J. Y. Sung}, journal={Gastroenterology}, year={2016}, volume={150 1}, pages={86-95.e3; quiz e13-4} }