The incidence of inflammatory bowel disease (IBD) is on the rise in Latin America. The aims of this study were to examine epidemiologic trends of IBD in Colombia by demographics, region, urbanicity, and to describe the IBD phenotype in a large well-characterized Colombian cohort. We used a national database of 33 million adults encompassing 97.6% of the Colombian population in order to obtain epidemiologic trends of IBD using International Classification of Diseases 10codes for adults with ulcerative colitis (UC) and Crohn disease (CD). We calculated the incidence and prevalence of UC and CD from 2010–2017 and examined epidemiologic trends by urbanicity, demographics, and region. We then examined the IBD phenotype (using Montreal Classification), prevalence of IBD-related surgeries, and types of IBD-medications prescribed to adult patients attending a regional IBD clinic in Medellin, Colombia between 2001 and 2017. The incidence of UC increased from 5.59/100,000 in 2010 to 6.3/100,000 in 2017 (relative risk [RR] 1.12, confidence interval (CI) (1.09–1.18), P < .0001). While CD incidence did not increase, the prevalence increased within this period. The Andes region had the highest incidence of IBD (5.56/100,000 in 2017). IBD was seen less in rural regions in Colombia (RR=.95, CI (0.92–0.97), p < .01). An increased risk of IBD was present in women, even after adjusting for age and diagnosis year (RR 1.06 (1.02–1.08), P = .0003). The highest IBD risk occurred in patients 40 to 59 years of age. In the clinic cohort, there were 649 IBD patients: 73.7% UC and 24.5% CD. Mean age of diagnosis in CD was 41.0 years and 39.9 years in UC. UC patients developed mostly pancolitis (43%). CD patients developed mostly ileocolonic disease and greater than a third of patients had an inflammatory, non-fistulizing phenotype (37.7%). A total of 16.7% of CD patients had perianal disease. CD patients received more biologics than UC patients (odds ratio: 3.20, 95% CI 2.19–4.69 P < .001). Using both a national representative sample and a regional clinic cohort, we find that UC is more common in Colombia and is on the rise in urban regions; especially occurring in an older age cohort when compared to Western countries. Future studies are warranted to understand evolving environmental factors explaining this rise.

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BACKGROUND: Inflammatory Bowel Disease (IBD) includes ulcerative colitis (UC) and Crohn's disease (CD), which are chronic inflammatory pathologies of the gastrointestinal tract whose etiology is multifactorial. During their life, patients with IBD may present with extraintestinal manifestations (EIMs), with a frequency of 6–47%, which may occur before or after the diagnosis of IBD. Data on the frequency of EIMs in IBD are scarce in Latin America. We conducted an observational and descriptive study to determine the frequency of MEIs in our patients with IBD, and describe their clinical behavior. METHODS: We retrospectively analyzed data from 759 patients with IBD from the Pablo Tobón Uribe Hospital in Medellin-Colombia, who have consulted since 2001 until February 2019. The following were considered extraintestinal manifestations: articular (axial and peripheral), primary sclerosing cholangitis (PSC), ophthalmological (episcleritis and uveitis), dermatological (oral ulcers, erythema nodosum, pyoderma gangrenosum, psoriasis). Peripheral joint manifestations were classified according to the Orchard classification and the axial manifestations according to the ASAS classification. Absolute and relative frequencies were used for the qualitative variables and for the quantitative variables, mean and standard deviation or median and interquartile range (P25-75) were used after verification of the assumption of normality with the Kolmogorov-Smirnov tests to compare two proportions the Chi square test of independence and the Odds Ratio (OR) was estimated with its respective 95% confidence interval. In all cases, a level of statistical significance was taken into account when the value p < 0.05. The statistical package Epidat version 3.1 was used. RESULTS: This registry has 759 patients with IBD (759), 544 have UC (71.6%), which is more frequent in women (53.4%), 200 patients have CD (26.3%), more frequent in men (57.5%), and 15 patients with unclassifiable IBD (1.9%). Of the total patients with IBD, 177 (23.3%) presented EIMs, 53.1% women and 46.9% men. 123 (22.6%) with UC and 53 (26.5%) with CD presented EIMs. Of 177 patients with EIMs, 145 (81.9%) presented only one, and 32 (18.1%) patients presented two or more. In 30.9% of patients, EIMs was presented before the diagnosis of IBD. Greater use of biological therapy with antibodies against tumor necrosis factor (Anti-TNFs) was found in patients with IBD compared to those without EIMs, 43.5% vs. 18.5%, OR 3.38, 95% CI: 2.31–4.90, P = 0.000. The above was also found for CU, 35.8% vs. 13.0%, OR 3.89 95% CI: 2.38–6.36, P = 0.00, and EC 56.6% vs. 39.9%, OR 3.35 95% CI: 1.74–6.46, P = 0.000. In 17.1% of patients with biological therapy, the indication of the use of Anti-TNFs was the EIMs. CONCLUSION(S): EIMs are frequent in patients with IBD in our environment, with both axial and peripheral joint manifestations more common in CD, and the presence of CEP in UC. Anti-TNFs are more commonly used in the coexistence of IBD with EIMs. Our study provides valuable information to the limited knowledge about the association of MEI and IBD in Latin America.