Siew C Ng1, Zhirong Zeng2, Ola Niewiadomski3, Whitney Tang4, Sally Bell3, Michael A Kamm3, Pinjin Hu2, H Janaka de Silva5, Madunil A Niriella5, W S A A Yasith Udara5, David Ong6, Khoon Lin Ling7, Choon Jin Ooi7, Ida Hilmi8, Khean Lee Goh8, Qin Ouyang9, Yu Fang Wang9, Kaichun Wu10, Xin Wang10, Pises Pisespongsa11, Sathaporn Manatsathit12, Satimai Aniwan13, Julajak Limsrivilai12, Jeffri Gunawan14, Marcellus Simadibrata14, Murdani Abdullah14, Steve W C Tsang15, Fu Hang Lo16, Aric J Hui17, Chung Mo Chow18, Hon Ho Yu19, Mo Fong Li19, Ka Kei Ng20, Jessica Y L Ching4, Victor Chan4, Justin C Y Wu4, Francis K L Chan4, Minhu Chen2, Joseph J Y Sung4. 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: siewchienng@cuhk.edu.hk. 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.
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.
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-tumornecrosis 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-tumornecrosis 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.