Severity of Disease, Management and Complications Among Mexican Americans, African Americans and Caucasians with Inflammatory Bowel Disease in the County Hospital Setting

Abstract

Purpose: Genetic and environmental factors play key roles in the pathogenesis of inflammatory bowel disease (IBD). Data is limited about the variability of IBD among minority ethnic groups such as African Americans and Mexican Americans. Methods: We performed a retrospective chart review of patients with IBD presenting from 1994 to 2008. We evaluated African American, Mexican American, Asian American and Caucasian patients with inflammatory bowel disease at the Lyndon B. Johnson county hospital. We included demographic characteristics, symptoms, severity of disease, management course and complications. Results: 74 patients with IBD were included, 28 Afican American (38%), 24 Mexican American (32%), 19 Caucasian (26%), and 3 Asians (4%). Among Mexican Americans, there were fewer female patients (46%) than male patients (54%). The incidence of Crohn's disease was greater in Caucasians (53%) as compared to both, Mexican Americans (29%) and African Americans (21%). There were no major differences in symptoms at presentation between the different ethnic groups. Pseudopolyps were more frequently found in Mexican Americans (50%) than Caucasians (10%) and African Americans (17%). A more profound anemia at presentation (hemoglobin < 10 mg%) was noted in African Americans (29%) and Mexican Americans (21%) in comparison to Caucasians (5%). 81% of patients were placed on 5-aminosalicylic acid agents without a difference in ethnic group. 63% of Caucasians received steroids versus 52% of African Americans and 45% of Mexican Americans. Immunomodulators were prescribed in 26% of Caucasians, 24% of African Americans and, 9% of Mexican Americans. Abscess or fistula formation was more common among Mexican Americans (20%) than Caucasians (5%) or African Americans (0%). Five patients had dysplasia or adenocarcinoma at time of presentation. Four patients were placed on biologic therapy. Conclusion: Although the presentation of inflammatory bowel disease among racial groups was similar in our population, the management and complications in Mexican Americans are different than African Americans and Caucasians. Mexican Americans are less likely to receive immunomodulators and more likely to have complications of disease.