Early course of inflammatory bowel disease in a population-based inception cohort study from 8 countries in Asia and Australia

Ng SC 1 , Zeng Z 2 , Niewiadomski O 3 , Tang W 4 , Bell S 3 , Kamm MA 3 Show all authors , Hu P 2 , de Silva HJ 5 , Niriella MA 5 , Udara WS 5 , Ong D 6 , Ling KL 7 , Ooi CJ 7 , Hilmi I 8 , Lee Goh K 8 , Ouyang Q 9 , Wang YF 9 , Wu K 10 , Wang X 10 , Pisespongsa P 11 , Manatsathit S 12 , Aniwan S 13 , Limsrivilai J 12 , Gunawan J 14 , Simadibrata M 14 , Abdullah M 14 , Tsang SW 15 , Lo FH 16 , Hui AJ 17 , Chow CM 18 , Yu HH 19 , Li MF 19 , Ng KK 20 , Ching JY 4 , Chan V 4 , Wu JC 4 , Chan FK 4 , Chen M 2 , Sung JJ 4 , Asia-Pacific Crohn’s and Colitis Epidemiology Study (ACCESS) Group

Affiliations 

  • 1 Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China. Electronic address: [email protected]
  • 2 The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
  • 3 St Vincent's Hospital and University of Melbourne, Melbourne, Victoria, Australia
  • 4 Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China
  • 5 Faculty of Medicine, University of Kelaniya, Regama, Sri Lanka
  • 6 National University Hospital of Singapore, Singapore, Singapore
  • 7 Singapore General Hospital, Singapore, Singapore
  • 8 University of Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 9 West China Hospital, Sichuan University, Chengdu, China
  • 10 Xijing Hospital, Fourth Military Medical University, Xian, China
  • 11 Maharaj Nakorn Chiangmai Hospital, Chiangmai, Thailand
  • 12 Siriraj Hospital, Bangkok, Thailand
  • 13 King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • 14 Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital
  • 15 Tseung Kwan O Hospital, Hong Kong, China
  • 16 North District Hospital, Hong Kong, China
  • 17 Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
  • 18 Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, China
  • 19 Kiangwu Hospital, Macau, China
  • 20 Hospital Conde S Januario, Macau, China
Gastroenterology, 2016 Jan;150(1):86-95.e3; quiz e13-4.
PMID: 26385074 DOI: 10.1053/j.gastro.2015.09.005

Abstract

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.
KEYWORDS: ACCESS; Natural History; Risk Factor; Treatment

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

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