South Asian Inflammatory Bowel Disease Research Articles

Identifying Care Challenges as Opportunities for Research and Education in Inflammatory Bowel Disease in South Asia

South Asia (SA) comprises Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. Despite a growing incidence of inflammatory bowel disease (IBD) in the South Asian population and global South Asian diaspora, the unique needs of this population have remained underrepresented in research, clinical practice, and advocacy. The South Asian IBD Alliance, as an international patient-clinician co-led charitable organization in the IBD domain, seeks to elevate care for the global South Asian community with IBD.

Incidence of Inflammatory Bowel Disease in South Asian and Chinese People: A Population-Based Cohort Study from Ontario, Canada.

BackgroundInflammatory bowel disease (IBD) is now a global disease with incidence increasing throughout Asia.AimTo determine the incidence of IBD among South Asians and Chinese people residing in Ontario, Canada’s most populous province.MethodsAll incident cases of IBD in children (1994–2015) and adults (1999–2015) were identified from population-based health administrative data. We classified South Asian and Chinese ethnicity using immigration records and surnames. We determined standardized incidence of IBD and adjusted incidence rate ratio (aIRR) in South Asians and Chinese compared to the general population.ResultsAmong 16,230,638 people living in Ontario, standardized incidence of IBD per 100,000 person-years was 24.7 (95% CI 24.4–25.0), compared with 14.6 (95% CI 13.7–15.5) in 982,472 South Asians and with 5.4 (95% CI 4.8–5.9) in 764,397 Chinese. The risk of IBD in South Asians was comparable to the general population after adjusting for immigrant status and confounders (aIRR 1.03, 95% CI 0.96–1.10). South Asians had a lower risk of Crohn’s disease (CD) (aIRR 0.66, 95% CI 0.60–0.77), but a higher risk of ulcerative colitis (UC) (aIRR 1.47, 95% CI 1.34–1.61). Chinese people had much lower rates of IBD (aIRR 0.24, 95% CI 0.20–0.28), CD (aIRR 0.21, 95% CI 0.17–0.26), and UC (aIRR 0.28, 95% CI 0.23–0.25).ConclusionCanadians of South Asian ethnicity had a similarly high risk of developing IBD compared to other Canadians, and a higher risk of developing UC, a finding distinct from the Chinese population. Our findings indicate the importance of genetic and environmental risk factors in people of Asian origin who live in the Western world.

P612 Dietary practices and beliefs of British South Asians with inflammatory bowel disease: A prospective UK study

Abstract Background The increasing incidence of inflammatory bowel disease (IBD) in newly industrialised countries and immigrant populations appears to outpace that which genetic influences alone could instigate. Environmental factors, in particular, the western diet, are therefore implicated in its aetiopathogenesis. Limited data exist on the dietary practices of the migrant South Asian population with IBD. We aim to describe the dietary practices of British South Asian IBD patients and information resources utilised to guide these beliefs. Methods A prospective, cross-sectional, questionnaire-based study is being conducted across hospitals in the UK. Two-hundred South Asian patients with IBD are being recruited to complete a questionnaire regarding demographics and dietary practices. Results Data from 118 patients are available to date. Mean patient age is 43 years (51% female). Sixty-five per cent have ulcerative colitis (UC) and 33% Crohn’s disease (CD). Fifty-one per cent are of Indian ethnicity, 37% Pakistani and 10% Bangladeshi. Forty-nine per cent of patients were born in the UK to parents who were born outside of the UK and 51% of patients were born outside the UK. Mean disease duration is 10.5 years. Forty-six per cent considered diet to be an initiating factor in their IBD, based on their own experience (85%) as well as information from internet resources (31%) and other patients with IBD (19%). Fifty-nine per cent of patients felt that diet had triggered a relapse of their disease. Most commonly reported foods were spicy (69%) and fatty foods (47%), milk products (44%) and red meat (37%). Eighty-six per cent of patients avoided certain foods in an attempt to prevent an IBD ‘flare’. Most frequently avoided foods were spicy foods (76%), fatty foods (69%), red meat (60%), coffee (55%), carbonated drinks (54%) and milk products (53%). One in four patients had tried a specific exclusionary diet, with 13% having tried a gluten-free diet in the absence of coeliac disease, to manage their symptoms. Just over a half of patients reported being able to find specific dietary advice for IBD, most commonly via the internet. Over half of patients avoided eating the same meal as their family or eating out to prevent relapse of their IBD. 1 in 3 consumed certain foodstuffs or nutritional supplements to prevent a relapse of IBD, most commonly turmeric in 25% of these patients. Conclusion Dietary restriction may be highly prevalent amongst the British South Asian IBD community with a high proportion reporting diet as an initiating factor and trigger for disease flares. Studies on immigrant populations may hold valuable clues regarding the influence of migration, environmental influences and drift from traditional cultural practices on IBD aetiopathogenesis and related symptoms. A larger dataset will be presented at conference proceedings.

819 Comparing Efficacy and Adverse Effects of Biological Agents in South Asian Inflammatory Bowel Disease Patients Living in the United States to Caucasian American Patients

INTRODUCTION: The aim of this study was to compare the efficacy and adverse effects of biological therapies in South Asian patients with Crohn’s disease (CD) and ulcerative colitis (UC) living in the United States with those of a Caucasian American cohort. METHODS: The efficacy, reasons for therapy discontinuation, and adverse effects of biological therapies in 73 South Asian patients (31 CD and 42 UC) who presented initially to our tertiary referral center from 2012 to 2016 and had subsequent follow-up were retrospectively compared with those of 408 consecutive Caucasian American patients (245 CD and 163 UC). The reasons for biologic therapy discontinuation were classified as: financial barrier, clinician judgment based on disease remission, primary non-response, secondary non-response, adverse effects, and patient preference. Adverse effects for biologic agents were classified as injection site reaction, infusion reactions, cytopenia, secondary infections, neurologic effects (including demyelinating disease or vestibular issues), cardiac effects (including heart failure), cutaneous effects, malignancy, and others. RESULTS: For both the South Asian and Caucasian American cohorts, adalimumab and infliximab were the most commonly prescribed biologic agents. Twenty-two out of 22 (100%) South Asian CD patients treated with adalimumab or infliximab had primary response. The Caucasian American CD cohort had a primary non-response rate of 16.5% to adalimumab and 12.1% to infliximab (Table 1). There was no statistical difference noted in the incidence of secondary non-response due to immunogenicity between South Asian and Caucasian American CD patients. Primary non-response, secondary non-response and adverse effects were the leading reasons for discontinuing biological therapy in both UC cohorts (Table 2). South Asian and Caucasian American CD patients experienced similar rates of adverse effects to anti-TNF therapy (Table 3). South Asian UC patients had a higher rate of primary non-response and a lower rate of adverse events with infliximab therapy compared to Caucasian American UC patients (Table 3). CONCLUSION: A cohort of South Asian IBD patients, mainly migrants, showed differing rates of response and adverse effects to biological therapies compared to a Caucasian American cohort. Of note, South Asian CD patients had higher rates of primary response to anti-TNF therapy than Caucasian American CD patients. These results provide insights into ethnic and racial variation in IBD therapeutics.

Demographics and Phenotypic Behavior of Inflammatory Bowel Disease in South Asians Living in the United States

2807_A Figure 1. Characteristics of South Asian IBD patientsIntroduction: The incidence and prevalence rates of inflammatory bowel disease (IBD) has been rising in Southasian populations. Studies from United Kingdom and Canada have shown increased risk of developing IBD when immigration occurred at a younger age and incidence among second generation immigrants similar to non-immigrants suggesting the role of environment as a risk factor for developing IBD. Thus far no studies in the United States (US) population address this issue. Our aim was to determine the demographics, disease type, behavior and phenotypic variation of IBD in Southasians living in the US. Methods: Clinical and demographic data from adult Southasians with IBD were abstracted from review of medical records and telephone interview after institutional review board approval. Additional information regarding patients and parents' place of birth, time of immigration, family history of IBD, diet, smoking history, disease extent and behavior, as well as need for hospitalizations and surgical history was obtained. Results: Among 37 Southasians with IBD; 18 (49%) had ulcerative colitis (UC) and 19 (51%) had Crohn's disease (CD). Mean age at diagnosis was 27+/-11 years. 2 patients (11%) with UC and 2 patients (10%) with CD had a positive family history of IBD. Patient characteristics comparing UC versus CD is reported in Table 1. Additional data regarding immigration status and diet were obtained via telephone interview from 20 patients. Sixteen out of 20 were first generation immigrants [UC: 8(50%) and CD: 8(50%)]. Mean age at IBD diagnosis was significantly younger in second generation immigrants comparing to first generation immigrants (18+/-3 vs 32+/-14; p< 0.02). Prevalence of EIMs, hospitalizations and history of bowel surgeries were similar between first and second generation immigrants (Table 2). Although second generation had more of a westernized diet, this did not seem to influence the disease severity and/or behavior.2807_B Figure 2. Patient demographics and disease characteristics by generationConclusion: Disease extent and location in our Southasians was predominantly pancolitis in UC and ileocolonic in CD. Second generation patients were younger age at diagnosis of IBD and had more of a westernized diet, but no other differences were found in comparison to first generation patients. Information on racial variability in disease phenotypic expression may help identify both genetic and environmental factors associated with IBD.

Prevalence of Abnormal Hepatic Biochemistry and Associated Liver Disease in UK Based South Asians With Inflammatory Bowel Disease

Introduction: An association between Inflammatory Bowel Disease (IBD) and abnormal hepatic biochemistry has been hypothesized. Virtually no data exists for the prevalence of abnormal hepatic biochemistry in South Asian populations. The aim of our study was to investigate this in a cohort of UK based South Asian IBD patients. Methods: We conducted a retrospective study from a cohort of 106 South Asian IBD patients (51 female, mean age 42 years) over a 24-month period. Clinical data including demographics, disease characteristics and therapy were obtained from hospital records. IBD diagnosis was based on pre-defined criteria based on: symptoms, endoscopic appearance, radiological and histopathological features for Crohn's disease (CD) and ulcerative colitis (UC). Disease was phenotyped to the Montreal Classification. Abnormal hepatic biochemistry was defined as elevation above the laboratory upper limit of normal for ALT and/or ALP during the time period. Investigations performed to identify the cause of the abnormalities were noted. Chi2 and unpaired t-tests were used to compare patients with normal vs. abnormal hepatic biochemistry. Results: Serial hepatic biochemistry was available for all 106 patients (CD=29, UC=73 and IBD-U=4). Abnormal hepatic biochemistry was noted in 22/106 (21%) patients. Of these, only 9/22 patients (41%) had further investigations. Liver pathology was noted in 5/22 patients (PSC n=2, autoimmune hepatitis n=1, fatty liver disease n=1 and drug induced liver injury n=1). When comparing the groups with normal and abnormal hepatic biochemistry a significant association was found with Mercaptopurine use (p=0.025) and CD classification (p=0.05). No associations were found with biologics, cyclosporine, azathioprine, corticosteroids, 5-ASA, disease activity, UC phenotype, age, gender or diagnosis (CD or UC). Conclusion: The incidence of abnormal hepatic biochemistry in our South Asian cohort is similar to that reported in a Caucasian population (1) and 23% of our patients had associated liver disease. We noted a significant association between Mercaptopurine use and abnormal liver biochemistry, which is intriguing with previous reports of ethnicity related pharmacokinetics. Abnormal liver chemistry in IBD patients is suboptimally investigated. Further research exploring associations and etiology is much needed.

PTU-060 Phenotypic Characterisation of Inflammatory Bowel Disease in South Asians in the United Kingdom-Insights into a Shifting Landscape

IntroductionThe aetiology of inflammatory bowel disease (IBD) remains elusive. The increasing incidence of IBD in developing countries and immigrant populations appears to outpace what genetic influences alone could instigate. There...

PTU-061 Vitamin D Deficiency is Widely Prevalent in South Asian Patients with Inflammatory Bowel Disease

IntroductionThere has been resurgent interest in recent years in the pro-hormone vitamin D in its role and plausible effects on immune regulation and inflammatory bowel disease (IBD). We postulated a...

Phenotypic Characterisation of Inflammatory Bowel Disease in South Asians in the United Kingdom: Insights into a Shifting Landscape

Purpose: The aetiology of inflammatory bowel disease (IBD) remains elusive; a complex interplay of genetic, environmental and immunological influences. The increasing incidence of IBD in developing countries and immigrant populations appears to outpace what genetic influences alone could instigate and may provide valuable insights into aetiology. There is a relative dearth of literature on the phenotypic characteristics of South Asian immigrant populations. The aim of our study was to define the clinical phenotype of IBD in South Asians living in North-West England. Methods: We conducted a retrospective study of 102 patients of South Asian origin attending IBD clinics at our hospital. Clinical data including demographics, disease characteristics (Montreal classification), treatment and blood results were obtained using electronic case records. Results: Of 102 patients reviewed, 54 were male. The median age was 38 years (range 16-80) and mean disease duration was 9.4 years. Seventy-three patients had ulcerative colitis (UC) and 29 had Crohn's disease (CD). Five patients were current or ex smokers (4.9%). Seventeen patients had extra-intestinal manifestations of IBD (16.7%). Of UC patients 35 had pancolitis, 33 left sided disease and 5 had proctitis. Of patients with CD, 3 had ileal disease, 10 colonic disease and 16 had ileocolonic disease. Five CD patients had stricturing disease, 10 had penetrating disease (6 also stricturing) and 14 had non-penetrating, non-stricturing disease. Perianal disease was noted in 3 at diagnosis and 5 subsequently developed it. Eighty patients received steroids, topical steroids (29), 5-ASA (96), topical 5-ASA (30), azathioprine (55), 6-mercaptopurine (4), cyclosporine (2), methotrexate (9), infliximab (20) and adalimumab (9). Fifty-seven patients received at least one immunomodulatory therapy with the median time to use being 12 months (range 0-276 mo). Thirteen patients (7 CD, 3 UC) required surgery (3 total colectomy, 10 subtotal). Mean time to surgery was 4 years (range 0-13 years). Seventeen patients had disease progression leading to Montreal reclassification (median time 60 months; range 1-216 mo). Conclusion: We noted a higher prevalence of UC with a predominance of pancolonic disease and a significant proportion of CD with penetrating or stricturing disease. The majority of patients required immunomodulatory therapy with the median time to use being only 12 months, suggesting a relatively more aggressive disease course. Epidemiologic insights from such populations may provide further clues in defining an aetiological paradigm for IBD and should form an important area of further research. A case control study exploring differences is underway at our institution.

Vitamin D Deficiency is Widely Prevalent in South Asian Patients with Inflammatory Bowel Disease

Purpose: There has been resurgent interest in recent years in the pro-hormone vitamin D beyond its classical role in bone metabolism to its role and plausible effects on immune regulation and inflammatory bowel disease (IBD). We postulated a wide prevalence of vitamin D deficiency in South Asian patients with implications for the control of their IBD. The aim of our study was to review vitamin D assessment in a South Asian IBD cohort. Methods: We conducted a retrospective review of 102 South Asian patients attending IBD clinics in our institution. Clinical data including demographics, disease characteristics (Montreal classification) and therapy were obtained from electronic record review. Serum 25-hydroxyvitamin D (25-OHD) concentrations were recorded in all patients tested and in all having serial measurements. Results: Of 102 patients reviewed 54 were male. The median age was 38 years (range 16-80), and mean disease duration was 9.4 years. Seventy-three patients had ulcerative colitis (UC) and 29 had Crohn's disease (CD). Five patients were current or ex smokers (4.9%). Vitamin D status was assessed in 51 patients (50%), 25 had serial measurements. Median 25-OHD was 8.85 (range 3.3-44.4). Fifty patients had levels <25 ng/ml consistent with deficiency and all 51 had insufficient levels <50 ng/ml. Of the patients with deficiency 34 had UC and 16 had CD. Of the UC patients, 17 had pancolitis, 13 had left sided disease and 4 proctitis. Of the CD patients 5 had penetrating disease and 4 had stricturing disease. Forty-two of the deficient patients had received steroids and 29 received immunomodulatory therapy (27 azathioprine, 3 methotrexate, 1 cyclosporin, 2 6MP, 10 infliximab, 6 adalimumab. Seven deficient patients (4 CD, 3 UC) required a colectomy and the mean 25-OHD level in this group was 10.7 (range 4.0-20.1 ng/ml). Mean time to surgery was 3.6 years (range 0-8 years). Of the CD patients 1 had a subtotal colectomy, 3 had hemicolectomy and of the UC patients 2 had subtotal colectomy and 1 had total colectomy. Conclusion: There was a high prevalence of Vitamin D deficiency in our patient cohort although assessment was suboptimal and probably reflective of a wider experience with disparate practices elsewhere. Patients with vitamin D deficiency appeared to have a more aggressive disease course with 14% of deficient patients requiring surgical management. The immunopathogenesis of vitamin D in IBD is a science in evolution underpinning exciting implications for gastroenterological research. Meanwhile vitamin D deficiency is under-recognised and consequently undertreated with likely implications for adequate disease control in this potentially vulnerable group.

Differences in Inflammatory Bowel Disease Phenotype between South Asians and Northern Europeans Living in North West London, UK

The incidence and prevalence of inflammatory bowel disease (IBD) is increasing throughout Asia. Since the 1950s, there has been substantial migration from South Asia (India, Pakistan, and Bangladesh) to the United Kingdom. The aim of this study was to define the clinical phenotype of IBD in UK South Asians living in North West London, and to compare the results with a white Northern European IBD cohort. The phenotypic details of 367 South Asian IBD patients (273 ulcerative colitis (UC) and 94 Crohn's disease (CD)), undergoing active follow-up in five North West London hospitals, were compared with those of 403 consecutively collected white Northern European IBD patients (188 UC and 215 CD). The phenotype of IBD differed significantly between the two populations. 63.0% of South Asian UC patients had extensive colitis compared with 42.5% of the Northern European cohort (P < 0.0001). Proctitis was uncommon in South Asian UC patients (9.9 vs. 26.1% in Northern European patients, P<0.0001). In the South Asian CD cohort, disease location was predominantly colonic (46.8%). CD behavior differed significantly between the groups, with less penetrating disease compared with Northern Europeans (P=0.01) and a reduced need for surgery (P=0.003). The phenotype of IBD in South Asians living in North West London is significantly different from that of a white Northern European IBD cohort. Knowledge of ethnic variations in disease phenotype may help to identify key genetic, environmental, and behavioral factors contributing to the development of IBD.

Ethnic variation in the frequency of IBD related polymorphisms in IRGM, ATG16L1 and IL23R

IntroductionRecent genome wide association studies have identified a number of key single nucleotide polymorphisms (SNPs) that contribute to the susceptibility of inflammatory bowel disease (IBD). SNPs in the autophagy-related 16-like...

Ethnic variation in the annual rates of adult inflammatory bowel disease in hospitalized patients in Vancouver, British Columbia.

There is currently little available information regarding the impact of ethnicity on the clinical features of inflammatory bowel disease (IBD). Migrating populations and changing demographics in Vancouver, British Columbia (BC) provide a unique opportunity to examine the role of ethnicity in the prevalence, expression and complications of IBD. To determine the demographics of IBD and its subtypes leading to hospitalization in the adult population of BC. A one-year retrospective study was performed for all patients who presented acutely with IBD to Vancouver General Hospital from January 1, 2006 to December 31, 2006. Data regarding sex, age, ethnicity, IBD type and extent of disease, complications and management strategies were collected. Clinical data were confirmed by pathology and radiology reports. There were 186 cases of IBD comprising Crohn's disease (CD) 56%, ulcerative colitis (UC) 43% and indeterminate colitis (1%) 1%. The annual rate of IBD cases warranting hospitalization in Caucasians was 12.9 per 100,000 persons (7.9 per 100,000 persons for CD and 5.0 per 100,000 persons for UC). This was in contrast to the annual rate of IBD in South Asians at 7.7 per 100,000 persons (1.0 per 100,000 persons for CD and 6.8 per 100,000 persons for UC) and in Pacific Asians at 2.1 per 100,000 persons (1.3 per 100,000 persons for CD, 0.8 per 100,000 persons for UC). The male to female ratio was higher in South Asians and Pacific Asians than in Caucasians. The extent of disease was significantly different across racial groups, as was the rate of complications. These early results suggest that there are ethnic disparities in the annual rates of IBD warranting hospitalization in the adult population of BC. There was a significantly higher rate of CD in the Caucasian population than in South Asian and Pacific Asian populations. The South Asian population had a higher rate of UC, with an increased rate of complications and male predominance. Interestingly, the rate of CD and UC was lowest in the Pacific Asian population. These racial differences - which were statistically significant - suggest a role for ethnodiversity and environmental changes in the prevalence of IBD in Vancouver.

T1280 The Prevalence and Clinical Significance of Atypical Perinuclear Anti-Neutrophil Cytoplasmic Antibody in UK South Asian Inflammatory Bowel Disease Patients

T1280 The Prevalence and Clinical Significance of Atypical Perinuclear Anti-Neutrophil Cytoplasmic Antibody in UK South Asian Inflammatory Bowel Disease Patients

PTU-047 Tolerability of thiopurines in a UK South Asian inflammatory bowel disease population

Introduction The thiopurine drugs, azathioprine and mercaptopurine are commonly used in the treatment of both Crohn9s disease (CD) and ulcerative colitis (UC). In general, they are well tolerated and safe. However, side effects, serious enough to warrant drug withdrawal, are reported in up to 24% of patients.1 Common reasons for thiopurine withdrawal include gastric intolerance, leucopaenia and deranged liver function tests. Previous studies in the UK have concentrated on Caucasian IBD populations; there are no previous studies of the tolerability of thiopurine drugs in the UK South Asian IBD population. Methods The aim of this study was to determine the frequency of thiopurine withdrawal in a UK South Asian IBD cohort. The medical notes of South Asian inflammatory bowel disease patients attending clinic in five North West London hospitals between 2007 and 2009 were reviewed. Any patients treated with thiopurines were noted and patients withdrawing from treatment within 6 months of starting treatment were recorded. Results Three hundred and seventy-one South Asian IBD patients were identified. One hundred and fifty-one patients (41%) were started on a thiopurine. In 34.4% of cases (52/151) South Asian patients stopped first-line immunosuppression with a thiopurine within 6 months of starting. In five cases the reason for drug withdrawal was not documented. In the remaining 47 cases, the reasons reported for stopping the drug included gastric intolerance (17), flu-like symptoms (3), pancreatitis (5), hepatitis (3), rash (3), myelotoxicity (3) and non-specific symptoms (including headache, itching, increased urinary frequency and paraesthesia) (13). Conclusion This study has revealed a high level of thiopurine withdrawal in a cohort of South Asian IBD patients. Although TPMT levels were not available for all South Asian patients in our study, previous research has shown that TPMT polymorphisms are of a similar frequency in British Caucasians and South Asians. A high proportion of South Asian patients stopped thiopurine treatment for non-specific symptoms (13/47; 28%). A possible reason to explain this could be difficulty in communication with non-English speaking patients, in particular a lack of drug information leaflets translated into other languages. This may mean that patients do not know what to expect when starting thiopurines. Clinicians need to be aware of this and information leaflets on thiopurines should be translated for ethnic minorities who are unable to read English.

PTU-046 The prevalence of extraintestinal manifestations associated with inflammatory bowel disease differs between ethnic groups in the UK

Introduction The incidence and prevalence of inflammatory bowel disease (IBD) is increasing throughout Asia. Since the 1950s, there has been substantial migration from South Asia (India, Pakistan, Bangladesh and Sri Lanka) to the UK. Currently 2.33 million South Asians live in the UK and 0.86 million live in London. There have been no previous studies reporting the prevalence of extraintestinal manifestations (EIMs) associated with IBD in this population. Methods The aim of the study was to establish whether there are differences in the prevalence of EIMs in a cohort of UK South Asian IBD patients compared with a British Caucasian IBD cohort. The medical notes of IBD patients attending five hospitals in North West London were monitored for a 2-year period between 2007 and 2009 to identify South Asian patients under active follow-up. IBD patients with any EIMs were recorded. EIMs were defined as joint complications (Type 1 or 2 peripheral arthropathy, ankylosing spondylitis and sacroiliitis), skin complications (erythema nodosum and pyoderma gangrenosum), anterior uvetitis and primary sclerosing cholangitis. The data were compared with an established database of British Caucasian IBD patients (609 ulcerative colitis (UC): 560 Crohn9s disease (CD)) using the χ 2 test. Results A total of 371 South Asian IBD patients were studied (271 UC: 100 CD). Forty-one patients (11%) had at least one EIM. Twenty-five (9.2%) of the South Asian UC population had an EIM associated with IBD. This was significantly lower than the Caucasian population (112/609; 18.4%) ( P =0.0005). The most common EIM in South Asians UC patients was type 1 (large joint) peripheral arthritis (7/271; 2.6%). EIMs were also more common in the Caucasian CD cohort (148/560; 26.4%) than the South Asian CD cohort (16/100; 16%) ( P =0.03). Erythema nodosum was the most common EIM in South Asian CD patients (5/100; 5%). Conclusion This is the first study of EIMs in a UK South Asian IBD cohort and shows that they are significantly less common compared to a British Caucasian IBD population. As several studies have reported an association between EIMs and HLA gene polymorphisms in Caucasians, differences in the prevalence of EIMs may reflect variation in HLA polymorphisms between the groups. Further genetic studies are required to determine the answer.

Inflammatory Bowel Disease in the South Asian Pediatric Population of British Columbia

Geographical differences, population migration, and changing demographics suggest an environmental role in prevalence, modulation, and phenotypic expression of inflammatory bowel disease (IBD). To determine the incidence of IBD and disease subtype in the pediatric South Asian population in British Columbia (BC) compared with non-South Asian IBD patients in the same geographic area. Chart review with data collected for all patients <or=16 yr of age diagnosed with IBD at B.C. Children's hospital, January 1985 to June 2005. Age, gender, family history, duration of symptoms, type, and extent of disease were extracted. Identified South Asian subjects were prospectively interviewed. Seventy-five South Asian patients were diagnosed with IBD, 48% Crohn's disease (CD), 33.3% ulcerative colitis (UC), and 18.7% with indeterminate colitis (IC), in contrast to 71%, 18.8%, and 10.2%, respectively, in the non-South Asian population. The incidence rate for South Asian IBD patients, for the period 1996-2001 was 15.19/10(5) (6.41/10(5) for CD, 6.70/10(5) for UC, and 2.08/10(5) for IC) compared with 5.19/10(5) for the non-South Asian IBD group (3.69/10(5), 0.96/10(5), and 0.54/10(5), respectively). The South Asian male/female ratio was significantly different from that observed for the rest of the population. These data suggest a significantly higher incidence of IBD in the South Asian pediatric population compared with the rest of the BC pediatric population, with a different pattern of phenotypic expression, a male predominance, and more extensive colonic disease. These data suggest a potential effect of migration, and environmental and lifestyle change on the incidence of IBD and disease subtype.