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      Ethnic differences in inflammatory bowel disease: Results from the United Kingdom inception cohort epidemiology study

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          Abstract

          BACKGROUND

          The current epidemiology of inflammatory bowel disease (IBD) in the multi-ethnic United Kingdom is unknown. The last incidence study in the United Kingdom was carried out over 20 years ago.

          AIM

          To describe the incidence and phenotype of IBD and distribution within ethnic groups.

          METHODS

          Adult patients (> 16 years) with newly diagnosed IBD (fulfilling Copenhagen diagnostic criteria) were prospectively recruited over one year in 5 urban catchment areas with high South Asian population. Patient demographics, ethnic codes, disease phenotype (Montreal classification), disease activity and treatment within 3 months of diagnosis were recorded onto the Epicom database.

          RESULTS

          Across a population of 2271406 adults, 339 adult patients were diagnosed with IBD over one year: 218 with ulcerative colitis (UC, 64.3%), 115 with Crohn's disease (CD, 33.9%) and 6 with IBD unclassified (1.8%). The crude incidence of IBD, UC and CD was 17.0/100000, 11.3/100000 and 5.3/100000 respectively. The age adjusted incidence of IBD and UC were significantly higher in the Indian group (25.2/100000 and 20.5/100000) compared to White European (14.9/100000, P = 0.009 and 8.2/100000, P < 0.001) and Pakistani groups (14.9/100000, P = 0.001 and 11.2/100000, P = 0.007). The Indian group were significantly more likely to have extensive disease than White Europeans (52.7% vs 41.7%, P = 0.031). There was no significant difference in time to diagnosis, disease activity and treatment.

          CONCLUSION

          This is the only prospective study to report the incidence of IBD in an ethnically diverse United Kingdom population. The Indian ethnic group showed the highest age-adjusted incidence of UC (20.5/100000). Further studies on dietary, microbial and metabolic factors that might explain these findings in UC are underway.

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          Most cited references33

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          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

          The discovery of a series of genetic and serological markers associated with disease susceptibility and phenotype in inflammatory bowel disease has led to the prospect of an integrated classification system involving clinical, serological and genetic parameters. The Working Party has reviewed current clinical classification systems in Crohn’s disease, ulcerative colitis and indeterminate colitis, and provided recommendations for clinical classification in practice. Progress with respect to integrating serological and genetic markers has been examined in detail, and the implications are discussed. While an integrated system is not proposed for clinical use at present, the introduction of a widely acceptable clinical subclassification is strongly advocated, which would allow detailed correlations among serotype, genotype and clinical phenotype to be examined and confirmed in independent cohorts of patients and, thereby, provide a vital foundation for future work.
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            Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn's and colitis epidemiology study.

            Inflammatory bowel diseases (IBD) are becoming more common in Asia, but epidemiologic data are lacking. The Asia-Pacific Crohn's and Colitis Epidemiology Study aimed to determine the incidence and phenotype of IBD in 8 countries across Asia and in Australia. We performed a prospective, population-based study of IBD incidence in predefined catchment areas, collecting data for 1 year, starting on April 1, 2011. New cases were ascertained from multiple overlapping sources and entered into a Web-based database. Cases were confirmed using standard criteria. Local endoscopy, pathology, and pharmacy records were searched to ensure completeness of case capture. We identified 419 new cases of IBD (232 of ulcerative colitis [UC], 166 of Crohn's disease [CD], and 21 IBD-undetermined). The crude annual overall incidence values per 100,000 individuals were 1.37 for IBD in Asia (95% confidence interval: 1.25-1.51; 0.76 for UC, 0.54 for CD, and 0.07 for IBD-undetermined) and 23.67 in Australia (95% confidence interval: 18.46-29.85; 7.33 for UC, 14.00 for CD, and 2.33 for IBD-undetermined). China had the highest incidence of IBD in Asia (3.44 per 100,000 individuals). The ratios of UC to CD were 2.0 in Asia and 0.5 in Australia. Median time from symptom onset to diagnosis was 5.5 months (interquartile range, 1.4-15 months). Complicated CD (stricturing, penetrating, or perianal disease) was more common in Asia than Australia (52% vs 24%; P = .001), and a family history of IBD was less common in Asia (3% vs 17%; P < .001). We performed a large-scale population-based study and found that although the incidence of IBD varies throughout Asia, it is still lower than in the West. IBD can be as severe or more severe in Asia than in the West. The emergence of IBD in Asia will result in the need for specific health care resources, and offers a unique opportunity to study etiologic factors in developing nations. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.
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              A simple index of Crohn's-disease activity.

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                Author and article information

                Contributors
                Journal
                World J Gastroenterol
                World J. Gastroenterol
                WJG
                World Journal of Gastroenterology
                Baishideng Publishing Group Inc
                1007-9327
                2219-2840
                28 October 2019
                28 October 2019
                : 25
                : 40
                : 6145-6157
                Affiliations
                Gastroenterology, St. Mark’s Hospital and Academic Institute, London HA1 3UJ, United Kingdom. rm399@ 123456ic.ac.uk
                The Pennine Acute Hospitals NHS Trust, Institute of Inflammation and Repair, University of Manchester, Manchester BL9 7TD, United Kingdom
                Gastroenterology, University Hospitals Birmingham, Birmingham B12 2TH, United Kingdom
                Gastroenterology, St. Mark’s Hospital and Academic Institute, London HA1 3UJ, United Kingdom
                Gastroenterology, Royal Wolverhampton NHS Trust, London WV10 0QP, United Kingdom
                Gastroenterology, Sandwell and West Birmingham Hospitals, Birmingham B71 4HJ, United Kingdom
                Gastroenterology, University Leicester Hospitals, Leicester LE1 5WW, United Kingdom
                Gastroenterology, Heartlands Hospital, Birmingham B9 5SS, United Kingdom
                Gastroenterology, University Hospitals Birmingham, Birmingham B12 2TH, United Kingdom
                Department of Gastroenterology, North Zealand University Hospital, Frederikssund 3600, Denmark
                Department of Gastroenterology, North Zealand University Hospital, Frederikssund 3600, Denmark
                Gastroenterology, St. Mark’s Hospital and Academic Institute, London HA1 3UJ, United Kingdom
                Author notes

                Author contributions: Misra R and Arebi N designed the study; Misra R analysed the data; Sakuma S supervised the study centres; Misra R and Arebi N wrote the paper; all authors critically appraised the paper and recruited patients to the study.

                Corresponding author: Ravi Misra, BSc, MRCP, Doctor, Consultant Gastroenterologist, Department of Gastroenterology, St. Mark’s Hospital and Academic Institute, Watford Rd, Harrow, London HA1 3UJ, United Kingdom. rm399@ 123456ic.ac.uk

                Telephone: +44-208-8695328

                Article
                jWJG.v25.i40.pg6145
                10.3748/wjg.v25.i40.6145
                6824277
                e7d8f176-4281-455b-8f39-ec31fb9e3810
                ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.

                This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                : 3 June 2019
                : 1 August 2019
                : 9 September 2019
                Categories
                Observational Study

                inflammatory bowel disease,ethnicity,epidemiology,incidence,phenotype

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