Inflammatory Bowel Disease in Indigenous Populations: A Scoping Review

Background Globally, Inflammatory Bowel Disease (IBD) rates have surged; however, Indigenous/Native/Aboriginal populations (i.e., the original inhabitants of a geographical region) are underrepresented in research and often face unique challenges in accessing healthcare due to socioeconomic barriers stemming from historic inequities. Aims This scoping review aimed to synthesize available literature on IBD in Indigenous populations globally, identify research gaps, and propose recommendations to improve research inclusivity. Methods A literature search was conducted across eight online databases: MEDLINE, EMBASE, CINAHL, SCOPUS, Web of Science, i-portal, Native Health Database, and ASTIS. We included qualitative, quantitative, and mixed-method research in this review, as well as commentaries, editorials, and abstracts published between 1960 and 2023. Eligibility criteria included publications in English focused on IBD Indigenous populations. Two reviewers independently screened titles and abstracts. The included publications were summarized and appraised using the Joanna Briggs Institute critical appraisal tools. Results Eighteen publications were included in the review, with most originating from Canada (n=7), New Zealand (n=5), and Australia (n=4). There was one study from Chile and another from the United States. Results showed a lower prevalence of IBD in Indigenous populations compared to the general population, but some recent studies reported an increasing prevalence of IBD among Indigenous populations from different countries. These changes are hypothesized to result from urbanization, changes in diet, sanitation, or other environmental changes. Also, a study from Canada showed that Indigenous peoples face inequities in accessing IBD care. Apart from 3 papers from Canada, 15 of the 18 publications had no evidence of working with Indigenous community members during the research process. Conclusions This scoping review highlights gaps in the literature about IBD in Indigenous populations. While the prevalence of IBD among Indigenous peoples is low, evidence demonstrates that rates are rising. Further research is required to continue studying the rising rates of IBD in Indigenous populations, alongside the genetic and environmental factors contributing to these trends. A focus on patient-centered research should also be emphasized. Indigenous peoples must be included as research partners and Indigenous research protocols must be followed to address health inequities and improve the health and well-being of Indigenous peoples living with IBD. Funding Agencies None

The Impact of Inflammatory Bowel Disease in Canada 2018: Epidemiology.

Inflammatory bowel disease in children and adolescents: Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition.

Background Worldwide, the epidemiology of inflammatory bowel disease (IBD) has been widely studied in the general population; however, there is limited-to-no evidence about IBD among Indigenous peoples, specifically among First Nations (FNs). Saskatchewan (SK) is a province in western Canada with a population of 1.1 million, 11% of whom are FNs. We aimed to estimate the prevalence, incidence, and trends of IBD among FNs in SK since 1999. Methods As part of a patient-oriented research project, we conducted a retrospective population-based study between 1999 and 2016 fiscal years using administrative data for the province of SK. A previously validated algorithm that required multiple health care contacts was applied to identify IBD cases (Crohn’s disease [CD] and ulcerative colitis [UC]). The ‘self-declared FN status’ variable in the Person Health Registration System was used to determine FNs meeting the IBD case definition and the population at risk. Generalised linear models (GLMs) with generalised estimated equations and a negative binomial distribution were used to estimate the annual prevalence of IBD, CD, and UC. Incidence rates and their corresponding 95% confidence intervals (95%CI) were estimated using GLMs with a negative binomial distribution. The GLMs were used to test trends overtime. Results The annual prevalence of IBD among FNs in SK increased from 64 (95%CI 62–66) per 100,000 people in 1999 to 142 (95%CI 140–144) per 100,000 population in 2016. Also, the prevalence of CD and UC increased during the study period, with 53/100,000 (95%CI 52–55) for CD and 87/100,000 (95%CI 86–89) for UC in 2016. The average increase in the prevalence of IBD was 4.2% (95%CI 3.2–5.2) per year, with similar trends observed in CD (4.1% [95%CI 3.3–4.9]) and UC (3.4% [95%CI 2.3–4.6]). The incidence rates of IBD among FNs were 11 (95%CI 5–25) per 100,000 people in 1999 and 3 (95%CI 1–11) per 100,000 population in 2016. No statistically significant changes were observed in the incidence rates over time (p = 0.09). Conclusion This study is the first epidemiological work providing detailed evidence of IBD among FNs. We identified that FNs have increasing trends in the prevalence of IBD, which has also been described in the Canadian general population. In contrast to the general population of Canada and other developed countries that have shown decreasing trends, the incidence rates of IBD among FNs appear to be stable over time. Also, among FNs, UC appears to be more prevalent than CD; this pattern has been observed in the general populations of developing countries. These results illuminate the need to advocate for better health care and wellness for FNs living with IBD.

Introduction. Axial spondylitis is a chronic inflammatory disease primarily affecting the axial skeleton but can also involve peripheral joints. Axial spondylitis is often associated with extra-articular manifestations, such as inflammatory bowel diseases, emphasizing the need for rigorous monitoring and personalized therapeutic approaches. The interactions between axial spondylitis and inflammatory bowel diseases fall under the concept of “immune-mediated inflammatory diseases”, sharing common pathogenetic mechanisms. This study analyzes the prevalence and characteristics of inflammatory bowel diseases in patients with axial spondylitis. Objective. The objective of this study was to describe the baseline characteristics of patients with axial spondylitis, evaluate the prevalence of inflammatory bowel diseases in this population, and identify correlations between the two conditions, contributing to a better understanding of their pathogenetic and clinical interactions. Material and methods. This prospective observational study included 257 axial spondylitis patients followed over two years. Patients were selected according to ASAS criteria for axial spondylitis and clinical guidelines for inflammatory bowel diseases. Analyses included clinical evaluations, laboratory tests, and imaging studies. Data were processed using SPSS v22.0. Continuous variables were expressed as mean ± standard deviation or median and interquartile range, and categorical variables as percentages. Correlations were assessed using Spearman’s coefficient, with results considered significant at p<0.05. Results. Among the 257 patients included (168 men and 89 women, mean age 48.2 ± 13.1 years), 13.2% were recently diagnosed with axial spondylitis. Of these, 5.1% had inflammatory bowel diseases, distributed as follows: Crohn’s disease (3.1%), ulcerative colitis (1.2%), and indeterminate colitis (0.8%). In 53.8% of cases, the diagnosis of inflammatory bowel diseases preceded axial spondylitis. Multivariate analysis identified the absence of a family history of axial spondylitis as a significant risk factor for inflammatory bowel diseases (OR = 3.4; p = 0.025). The prevalence of inflammatory bowel diseases increased with axial spondylitis duration, reaching 6.5% in patients with disease progression over eight years. Conclusions. The study highlights a high prevalence of inflammatory bowel diseases in axial spondylitis patients, indicating the need for rigorous clinical monitoring. The absence of a family history of axial spondylitis was identified as a major risk factor for inflammatory bowel diseases. These findings emphasize the importance of a multidisciplinary clinical approach, including active screening for inflammatory bowel diseases and collaboration between rheumatologists and gastroenterologists, to improve patient prognosis and quality of life.

SARS-CoV-2 Testing, Prevalence, and Predictors of COVID-19 in Patients with Inflammatory Bowel Disease in Northern California

AB0496 COMPARISON OF THE DISTRIBUTION BY DEPARTMENT OF THE PREVALENCE OF SPONDYLOARTHRITIS AND INFLAMMATORY BOWEL DISEASES IN METROPOLITAN FRANCE AND THEIR EVOLUTION BETWEEN 2008 AND 2018

Background Knowledge of Inflammatory Bowel Disease (IBD) prevalence allows health care administrators to understand disease burden and appropriately plan for research and medical care. Young IBD subjects often migrate from rural to urban areas for education and work opportunities, necessitating metropolitan prevalence studies to reduce under-representation. Also, the impact of urbanisation on IBD prevalence requires further exploration. Unlike IBD incidence, where young age-groups dominate, we hypothesised that the elderly age-groups would have the highest IBD prevalence given mortality rates being equivalent to the general population. We aimed to determine the first IBD prevalence rates for New South Wales, Australia. Methods This was an observational, population-based epidemiological study which captured disease information of people living with IBD within the metropolitan City of Canada Bay Local Government Area on the 1st of January 2016. The diagnosis was according to the Copenhagen Criteria. Age-standardisation was according to the WHO Standard Population. Results We identified 330 cases of IBD (49.1% male, median age 47, IQR=27, crude point prevalence rate of 371.5 per 100,000). Full diagnostic confirmation was achieved in 100%. The age-standardised point prevalence rate was 359.2 per 1 00 000. The crude point prevalence rates were 167.8, 158.8 and 45.0 per 1 00 000 for Crohn’s disease (CD), ulcerative colitis (UC) and IBD Unspecified (IBDU), respectively. The age-standardised rates were 171.6, 148.1 and 39.5 per 1 00 000 for CD, UC, and IBDU respectively. IBD prevalence steadily increased with age, peaking at 1061 per 1 00 000 in patients older than 85 years. A trend was observed between prevalence and socioeconomic status between suburbs. Conclusions Sydney exhibited the highest prevalence of IBD in Australasia. The extrapolated estimate for Australia was 89 000 people with IBD. Higher socioeconomic status and urbanisation may be contributing factors. The ageing IBD population accounts for the highest prevalence, peaking at greater than 1000 per 1 00 000. Safer therapies, cancer screening strategies and greater attention towards comorbidities are therefore of increasing importance in managing IBD patients.

The burden of inflammatory bowel disease (IBD) hasn't been reported in Iran. We aimed to estimate the prevalence and incidence of IBD and its trend in Iran at national and subnational level from 1990 to 2012. We conducted a systematic review of English and Persian databases about the epidemiology of IBD. We also collected outpatient data from 17 provinces of Iran using almost all public and private referral gastroenterology clinics. Prevalence and incidence rate was calculated at national and subnational levels. The Kriging method was used to extrapolate provinces with missing data and GPR model to calculate time trends of rates at subnational level. We found 16 case series, two population-based studies, and two review articles. We collected 11,000 IBD cases from outpatient databases. Among them, 9,269 (84.26%) had ulcerative colitis (UC), 1,646 (14.96%) had Crohn's disease (CD), and 85 had intermediate colitis (IC). A total of 5,452 (49.56%) patients were male. Mean age at diagnosis was 32.80 years (CI: 13 - 61) for UC and 29.98 years (CI: 11 - 58) for CD. Annual incidences of IBD, UC, and CD in 2012 were 3.11, 2.70, and 0.41 per 100,000 subjects respectively. Prevalence of IBD, UC, and CD in 2012 were 40.67, 35.52, and 5.03 per 100,000 subjects respectively. The incidence of UC and CD showed a significant increase during the study period (P for trend < 0.05). The incidence and prevalence of IBD are increasing in Iran. Establishing a national IBD registry seems necessary for comprehensive care of IBD patients in Iran.

Introduction: Inflammatory bowel disease (IBD), once considered disease of west is also increasingly diagnosed in Asia in recent years. As there are already studies about IBD in Southeast Asia like India, Srilanka, it would be more informative to study the disease in Maldives as being closer to India and Srilanka. This is probably the first study about the disease from Maldives conducted in a single tertiary hospital center. The objectives of the study were to determine the prevalence, clinical characteristics and treatment of IBD in Maldives. Methodology: A preliminary hospital-based retrospective observational study was performed in ADK multispecialty hospital, a referral tertiary center located in the capital city of Maldives. Patients visiting gastroenterology OPD, who were diagnosed as IBD either Crohn's disease (CD) or Ulcerative colitis (UC) on basis of internationally established standard practice, were recruited in the study after informed oral consents for the duration of three years from January, 2017 to December, 2020. We collected clinical data including gender, age at diagnosis, symptomatology, severity, smoking habits, family history, disease phenotype, and behavior at diagnosis from each involved patients as per clinical proforma prepared for UC and Crohn's disease in separate forms. Result: Total 41 patients of IBD with 15 CD and 26 UC were recruited during study period. The prevalence of IBD in the country was estimated to be at least 20 per 100000 persons. Ileocolonic phenotype in CD and Extended colitis in UC were more common. Clinically, majority IBD patients presented with moderate to severe form. Biologic agents were frequently used in IBD. Conclusion: The prevalence of IBD in Maldives is also more or less similar to other Asian countries where as some aspects of clinical characteristics are similar to Western countries. There needs to be nationwide epidemiological study or multi center hospital based prospective or at least cross sectional study for detail and optimal information about various aspects of IBD.

BackgroundCurrent evidence regarding the association of serum zonulin-related proteins (ZRP) levels with prevalent inflammatory bowel disease (IBD) is contradictory. Moreover, the association with the subsequent risk of incident IBD is still unexplored. This study aimed to investigate the association of serum ZRP levels with both prevalent and incident IBD.MethodThe study included a total of 130 women (51–61 years) from the Women’s Health in Lund Area (WHILA) study, which included 18 prevalent IBD (diagnosed before baseline) and 47 incident IBD diagnosed during the 17 years (median) follow-up and age- and sampling time-matched controls. Serum ZRP was tested in all participants by ELISA.ResultsThe serum ZRP levels were significantly higher in prevalent IBD compared to their matched controls (63.2 ng/ml vs 57.0 ng/ml, p = 0.02), however, no evidence of a difference in ZRP levels was found between the women who developed IBD during the follow-up period and their matched controls (61.2 ng/ml vs 59.7 ng/ml, p = 0.34). Using linear mixed models, we found that the association between serum ZRP levels and prevalent IBD (β = 6.2, p = 0.01), remained after adjusting for potential confounders. Conditional logistic regression models showed no evidence of an association between ZRP level and incident IBD (OR 1.03, p = 0.34).ConclusionHigher serum ZRP levels were associated with prevalent IBD, but not with incident IBD in our study samples.

Importance: The link between autoimmune gut disorders and different types of hair loss conditions has been recently investigated with an increased interest. With acknowledgement of the connection between immune dysregulation and the gut microbiome, this pathway is now becoming recognized as playing an important role in hair growth. The inflammatory cascade that results from the disruption of gut integrity such as seen in inflammatory bowel diseases (IBD) has been associated with certain types of alopecia. Objective: The aim of this work was to evaluate the association between alopecia and IBD. Evidence Review: A primary literature search was conducted using the PubMed, Embase, and Web of Science databases to identify articles on co-occurring alopecia and IBD from 1967 to 2020. A total of 79 studies were included in the review. A one-way proportional meta-analysis was performed on 19 of the studies to generate the pooled prevalence of alopecia and IBD. Finding: The pooled prevalence of non-scarring alopecia among IBD patients was 1.12% (k = 7, I² = 98.6%, 95% CI 3.1–39.9); the prevalence of IBD among scarring and non-scarring alopecia was 1.99% (k = 12; I² = 99%, 95% CI 6.2–34). The prevalence of non-scarring alopecia areata (AA) among IBD was compared to the prevalence of AA in the general population (0.63 vs. 0.1%; p < 0.0001). Similarly, the prevalence of IBD among the scarring and non-scarring alopecia groups was compared to the prevalence of IBD in the general population (1.99 vs. 0.396%; p = 0.0004). Conclusion: IBD and alopecia, particularly AA, appear to be strongly associated. Dermatology patients with alopecia may benefit from screening for IBD.

Seemingly conflicting results have been reported on the prevalence and severity of inflammatory bowel disease after liver transplantation. Regimens with different combinations of drugs can be used for immunosuppression after transplantation. To study retrospectively the prevalence of inflammatory bowel disease after liver transplantation, and the possible relationship with maintenance immunosuppressive regimens. All 78 patients with end-stage primary sclerosing cholangitis (48 patients) or autoimmune cirrhosis (30 patients), transplanted between 1979 and July 2001, and with a follow-up of at least 1 year, were eligible for this study. In addition to patient and transplant characteristics, data on inflammatory bowel disease and immunosuppression before and after transplantation were collected. The Kaplan-Meier method was used for survival analysis. Possible risk factors for inflammatory bowel disease after transplantation were analysed by Cox univariate and multivariate regression. The median follow-up after transplantation was 7.2 years (range, 1.1-22.3 years). Nine of 25 patients with pre-transplant inflammatory bowel disease experienced flare-ups after transplantation. Six of 53 patients without pre-transplant inflammatory bowel disease developed de novo inflammatory bowel disease after transplantation. The cumulative risks (standard errors in parentheses) for inflammatory bowel disease were 6% (3%), 12% (4%) and 20% (5%) at 1, 3 and 5 years after transplantation, respectively. The inflammatory bowel disease-free survival was significantly higher in patients not receiving tacrolimus vs. those receiving tacrolimus, in patients receiving azathioprine vs. those not receiving azathioprine and in patients taking the regimen prednisolone-azathioprine-ciclosporin A vs. those taking tacrolimus-prednisolone. Pre-transplant inflammatory bowel disease and the use of tacrolimus were found to be independent predictors for inflammatory bowel disease after transplantation. The prevalence of inflammatory bowel disease after liver transplantation is affected by the immunosuppression used. Azathioprine seems to have a protective effect and tacrolimus a promoting effect.

Background and aimsWe sought to define temporal changes in prevalence of inflammatory bowel disease (IBD) in East Devon, UK, in order to facilitate service planning over the next 5 years.MethodsMultiple...

Inflammatory bowel diseases (IBDs) such as ulcerative colitis (UC) and Crohn's disease (CD) are chronic autoimmune disorders that constitute a major societal and economic burden for individual patients, their families and the society. The aim of this study was to assess the current prevalence and treatment patterns of IBD in Poland. We carried out a retrospective analysis of the nationwide databases of the National Health Fund for the years from 2012 to 2014 to obtain data on the prevalence and treatment patterns of IBD. Patients with IBD were identified according to the ICD-10 codes indicated in medical records and the type of medical resource utilized during the study. Pharmacotherapy for IBD by age group, sex and IBD types was presented. The prevalence of IBDs was 157/100 000 individuals, including 35 patients with CD per 100 000 individuals. The use of drugs differed by age and diagnosis (P<0.001). Biologics, steroids and immunosuppressants were used more often by patients with CD than those with UC (13.2 vs. 0.3%, 54.5 vs. 37.5%, and 44.8 vs. 15.1%, respectively). Aminosalicylates were used more often by patients with UC than those with CD. Biologics were used most often by the youngest patients (≤18 years) and seldom by patients aged 65 years or older (7.7 and 0.1%, respectively). Our study showed a moderate prevalence of IBD in Poland. Treatment patterns depended on the patient's age and IBD type. The use of biologics was higher among young patients with CD than among older patients with other IBDs. Although not recommended, aminosalicylates were still commonly used in patients with CD, even during biologic and/or immunosuppressive treatment.