Abstract
BackgroundInflammatory bowel disease (IBD) was once considered as a Western disease. However, recent epidemiological data showed an emerging trend of IBD cases in the Eastern Asia countries. Clinico-epidemiological data of IBD in Malaysia is scarce. This study aimed to address this issue.MethodsRetrospective analysis of ulcerative colitis (UC) and Crohn’s disease (CD), diagnosed from January 1980 till June 2018 was conducted at our centre.ResultsA total of 413 IBD patients (281 UC, 132 CD) were identified. Mean crude incidence of IBD has increased steadily over the first three decades: 0.36 (1980–1989), 0.48 (1990–1999) and 0.63 per 100,000 person-years (2000–2009). In the 2010 to 2018 period, the mean crude incidence has doubled to 1.46 per 100,000 person-years. There was a significant rise in the incidence of CD, as depicted by reducing UC:CD ratio: 5:1 (1980–1989), 5:1 (1990–1999), 1.9:1 (2000–2009) and 1.7:1 (2010–2018). The prevalence rate of IBD, UC and CD, respectively were 23.0, 15.67 and 7.36 per 100,000 persons. Of all IBD patients, 61.5% (n = 254) were males. When stratified according to ethnic group, the highest prevalence of IBD was among the Indians: 73.4 per 100,000 persons, followed by Malays: 24.8 per 100,000 persons and Chinese: 14.6 per 100,000 persons. The mean age of diagnosis was 41.2 years for UC and 27.4 years for CD. Majority were non-smokers (UC: 76.9%, CD: 70.5%). The diseases were classified as follows: UC; proctitis (9.2%), left-sided colitis (50.2%) and extensive colitis (40.6%), CD; isolated ileal (22.7%), colonic (28.8%), ileocolonic (47.7%) and upper gastrointestinal (0.8%). 12.9% of CD patients had concurrent perianal disease. Extra intestinal manifestations were observed more in CD (53.8%) as compared to UC (12%). Dysplasia and malignancy, on the other hand, occurred more in UC (4.3%, n = 12) than in CD (0.8%, n = 1). Over one quarter (27.3%) of CD patients and 3.6% of UC patients received biologic therapy.ConclusionThe incidence of IBD is rising in Malaysia, especially in the last one decade. This might be associated with the urbanization and changing diets. Public and clinicians’ awareness of this emerging disease in Malaysia is important for the timely detection and management.
Highlights
Inflammatory bowel disease (IBD) was once considered as a Western disease
All data prior to 2013 were collected retrospectively and added into the registry. It aimed to capture all the relevant information related to IBD patients who are treated in UKM Medical Centre (UKMMC) which include sociodemographic details, disease characteristics, investigation results and treatment modalities
ulcerative colitis (UC) was much more common than Crohn’s disease (CD), there was a significant rise in the incidence of CD from the year 2000, as depicted by reducing UC:CD ratio: 5:1 (1980–1989), 5:1
Summary
Inflammatory bowel disease (IBD) was once considered as a Western disease. Inflammatory bowel disease is a chronic condition, characterized by relapsing and remitting inflammation of gastrointestinal (GI) tract. It encompasses Crohn’s disease [1] (CD), which can affect any segment of GI tract, and ulcerative colitis (UC), that involves exclusively the rectum and colon. Patients with UC and colonic CD most commonly present with chronic diarrhoea, per rectal bleeding and accompanied by abdominal pain. Ileocolonic CD mainly manifests as abdominal pain localized at periumbilical or right lower quadrant, with or without watery diarrhoea. Extra intestinal features for IBD include fever, weight loss, arthralgia, mucocutaneous lesions such as oral ulcers, erythema nodosum, pyoderma gangrenosum and ophthalmologic complications like episcleritis, iritis and uveitis [3]
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