A trend analysis of inflammatory bowel disease in non-endemic era (1993-2023)

Year 2024, Volume: 7 Issue: 5, 587 - 592, 27.09.2024

Yavuz Çağır , Muhammed Bahaddin Durak , Orhan Coşkun , İlyas Tenlik , Öykü Tayfur Yürekli , Mevlüt Hamamcı , Ali Atay , Abdurrahim Yıldırım Mücahit Ergül Oğuz Özturk , Ahmet Faruk Kalkışım Abdurrezzak Yılmaz , Emir Tuğrul Keskin Muhammed Mustafa İnce Ahmet Burak Fedai , Volkan Gökbulut , Çağdaş Kalkan , Ömer Öztürk , Aylin Demirezer Bolat , Mahmut Yüksel , Hasan Tankut Köseoğlu , İlhami Yüksel

https://doi.org/10.32322/jhsm.1541938

Abstract

Aims: In this study, we aimed to evaluate the demographic and epidemiological trends of ulcerative colitis (UC) and Crohn’s disease (CD) in non-endemic era for inflammatory bowel disease (IBD) during the past three decades.
Methods: UC and CD patients who had follow-up at least 6 months between June 1993 and February 2023 were evaluated retrospectively. Electronic medical databases, personal queries and IBD registries have all been used to collection data on the clinical and demographic characteristic of all patients.
Results: A total of 1549 adult patients with UC and CD were admitted to study. UC was diagnosed in 873 (56.4%) patients (male 538, 61.6%) and CD was diagnosed in 676 (43.6%) patients (male 404, 59.8%). Median total disease duration was 8.3 years in UC group, as well as 6.8 years in CD group. In patients with UC, proctitis was 154 (17.6%), left sided colitis was 410 (47%) and extensive colitis was 309 (35.4%). In CD patients, ileal involvement was found in 297 (43.9%), colonic in 76 (11.2%), ileo-colonic in 299 (44.2%) and isolated upper gastrointestinal involvement in 4 (0.6%) cases. 529 (78.3%) patients had inflammatory disease (non-stenosing non-penetrating behavior), 45 (6.7%) had stenosing behavior, 102 (15.1%) had penetrating behavior, as well as 196 (29%) patients had perianal disease. Mesalazine 658 (75.4%) and thiopurine 397 (45.5%) were the most frequently used conventional treatments for UC, while thiopurine 304 (45%) was most commonly used for CD patients. In the last two-decade, proportion of the biologic usage were 27.9% and 32.1% in UC patients 28.5% and 31.4% in CD patients respectively. Over the three decades, abdominal surgery was 49.2%, 27.8% and 36.3% in CD and colectomy rates was 2.0%, 2.7% and 3.7% in UC patients.
While the rate of UC patients has slightly decreased to 98 (61.6%), 401 (58.5%) and 374 (53%) frequency of CD patients has increased to 61 (38.4%), 284 (41.5%) and 331 (47%). Over the course of three decades, there were more UC patients than CD patients, however proportion of UC/CD has been continuously decreased (1.61, 1.41 and 1.13) for three decades respectively.
Conclusion: Our study showed that the frequency of UC and CD has significantly increased during the previous three decades in non-endemic era for IBD. While the frequency of UC patients has slightly decreased, that of CD patients has steadily increased over the past three decades. Although the use of biologics has significantly increased, proportions of the major abdominal surgeries and colectomies has not prominently changed.

Keywords

Inflammatory bowel disease, ulcerative colitis, crohn’s disease, three decades

Ethical Statement

The study was conducted in accordance with the ethical guidelines of the institutional research committee, the 1964 Declaration of Helsinki, and its subsequent amendments, or comparable ethical standards. The Ankara Bilkent City Hospital Scientific Research and Ethics Committee accepted the project on 25.01.2023 with approval No: E1-23-3218.

References

• Durak MB, Simsek C, İnan B, Yuksel I. Ileocecal valve that cannot be intubated in Crohn’s disease: is this a sign of poor prognosis? Int J Colorectal Dis. 2023;38(1):103.
• Cagir Y, Durak MB, Simsek C, Yuksel I. Specific oral manifestations in adults with Crohn’s disease. J Clin Med. 2024;13(13):3955.
• Gordon H, Minozzi S, Kopylov U, et al. ECCO guidelines on therapeutics in Crohn’s disease: medical treatment. J Crohns Colitis. 2024:jjae091. doi:10.1093/ecco-jcc/jjae091
• Cho JH. The genetics and immunopathogenesis of inflammatory bowel disease. Nat Rev Immunol. 2008;8(6):458-466.
• Erdoğan Ç, Durak MB, Alkan A, et al. Comparison of infliximab with adalimumab in biologic-naïve patients with Crohn’s disease: a single-center 13-year experience. Eur Rev Med Pharmacol Sci. 2023;27(12):5757-5766.
• Lin D, Jin Y, Shao X, et al. Global, regional, and national burden of inflammatory bowel disease, 1990-2021: insights from the global burden of disease 2021. Int J Colorectal Dis. 2024;39(1):139.
• Strober W, Fuss IJ. Proinflammatory cytokines in the pathogenesis of inflammatory bowel diseases. Gastroenterology. 2011;140(6):1756-1767.
• GBD 2019 Demographics Collaborators. Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019: a comprehensive demographic analysis for the global burden of disease study 2019. Lancet. 2020;396(10258):1160-1203. doi:10. 1016/S0140-6736(20)30977-6
• Silverberg MS, Satsangi J, Ahmad T, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a working party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005; 19(Suppl A):5A-36A.
• Kaplan GG, Windsor JW. The four epidemiological stages in the global evolution of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2021;18(1):56-66.
• Kim JE, Oh SJ, Lee CK. Forecasting the future prevalence of inflammatory bowel disease in Korea through 2048: an epidemiologic study employing autoregressive integrated moving average models. J Gastroenterol Hepatol. 2024;39(5):836-846.
• Ananthakrishnan AN, Kaplan GG, Ng SC. Changing global epidemiology of inflammatory bowel diseases: sustaining health care delivery into the 21st Century. Clin Gastroenterol Hepatol. 2020;18(6):1252-1260.
• Molodecky NA, Soon IS, Rabi DM, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142(1):46-54.
• Ng SC, Shi HY, Hamidi N, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet. 2020; 396(10256):e56.
• Coward S, Benchimol EI, Bernstein CN, et al. Forecasting the incidence and prevalence of inflammatory bowel disease: a Canadian nationwide analysis. Am J Gastroenterol. 2024;119(8): 1563-1570.
• Danpanichkul P, Duangsonk K, Lopimpisuth C, et al. Geographical and sociodemographic epidemiology of inflammatory bowel disease in young females from 2010 to 2019. Dig Liver Dis. 2024.
• Wang R, Li Z, Liu S, Zhang D. Global, regional and national burden of inflammatory bowel disease in 204 countries and territories from 1990 to 2019: a systematic analysis based on the global burden of disease study 2019. BMJ Open. 2023;13(3): e065186.
• Koloski NA, Bret L, Radford-Smith G. Hygiene hypothesis in inflammatory bowel disease: a critical review of the literature. World J Gastroenterol. 2008;14(2):165-173.
• Rizzello F, Spisni E, Giovanardi E, et al. Implications of the westernized diet in the onset and progression of IBD. Nutrients. 2019;11(5):1033.
• Weidner J, Kern I, Reinecke I, et al. A systematic review and meta-regression on international trends in the incidence of ulcerative colitis in children and adolescents associated with socioeconomic and geographic factors. Eur J Pediatr. 2024;183(4): 1723-1732.
• Bernstein CN, Eliakim A, Fedail S, et al. World Gastroenterology Organisation global guidelines inflammatory bowel disease: update August 2015. J Clin Gastroenterol. 2016;50(10):803-818.
• Greuter T, Manser C, Pittet V, Vavricka SR, Biedermann L. Gender differences in inflammatory bowel disease. Digestion. 2020;101(Suppl 1):98-104.
• Mak WY, Zhao M, Ng SC, Burisch J. The epidemiology of inflammatory bowel disease: east meets west. J Gastroenterol Hepatol. 2020;35(3):380-389.
• Zelinkova Z, Stokkers PC, van der Linde K, Kuipers EJ, Peppelenbosch MP, van der Woude CP. Maternal imprinting and female predominance in familial Crohn’s disease. J Crohns Colitis. 2012;6(7):771-776.