Epidemiology of Inflammatory Bowel Diseases , Where are the Iranian Cases ?

Abstract

Copyright © 2013, Colorectal Research Center and Health Policy Research Center of Shiraz University of Medical Sciences. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Dear Editor, We have read with interest the paper “Epidemiology of Inflammatory Bowel Diseases (IBD) in Iran”(1) by Dr. Taghavi’ AR et.al and would like to make few comments on this study. According to the first published literature from Fars (Shiraz) 44 years ago the authors claimed that there is no IBD in Iran (2). The first two reports of IBD in Iran which were designed to look for all cases of IBD [both ulcerative colitis (UC) and Crohn’s disease (CD)] came 28 years ago from Tehran and 27 years ago from Shiraz. In both surveys the authors could only find UC and they both confirmed that they couldn’t find even a single case of CD (3, 4). The first CD case was reported 13 years ago and now CD incidence is increasing and became close to the incidence of UC (5, 6). This epidemiologic pattern is similar to what happened in western countries during the first two decades after the emergence of IBD in Western hemisphere that is UC appeared first, followed by CD 15–20 years later and today CD is almost as common as UC. The most important causes of increasing IBD prevalence are life style changes, better hygiene, vaccination and cold chain theory rather than availability of diagnostic tools (7). The clinical presentation of CD in Iran appears in consistent with the classic presentation of the disease in western countries (3-5). The age-specific incidence curve is in agreement with many other epidemiological data (5). The percentages of extra intestinal complications are quite similar to western reports (8, 9). We have also shown that current smoking was a significant protective factor in UC, while prolong use of OCP, appendectomy and tonsillectomy were risk factors for CD (10) .These observations suggest that CD clinical features in Iran are similar to those previously reported in other countries. The burden of IBD in Iran and all other low and middle income countries are great given a lifelong disease with expensive therapy which become available to treat these patients (11). Acknowledgements