Demography and clinical course of ulcerative colitis in a multiracial Asian population: A nationwide study from Malaysia

Hilmi, Ida; Singh, Ram Raj; Ganesananthan, Sharmananthan; Yatim, I; Radzi, Megat Rusydi Megat; Chua, Ann; Tan, Huck Joo; Huang, S S; Chin, Kay; Menon, Jayaram; Goh, Khean Lee

doi:10.1111/j.1751-2980.2008.00357.x

Cited by 36 publications

(46 citation statements)

References 23 publications

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“…Most of the included studies were retrospective (36 articles). Among the included studies, six were from India, 12–17 four from Korea, 18–21 seven from Japan, 22–28 eight from China, 29–36 three each from Taiwan, 37–39 Singapore, 40–42 Malaysia, 43–45 and Israel, 46–48 two from Turkey, 49,50 and one each from Kuwait, 51 Sri Lanka, 52 Jordan, 53 Iran, 54 and Oman. 55 Six studies reported colorectal cancer risk in patients undergoing routine surveillance.…”

Section: Resultsmentioning

confidence: 99%

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Risk of colorectal cancer in Asian patients with ulcerative colitis: a systematic review and meta-analysis

Bopanna

Ananthakrishnan

Kedia

et al. 2017

The Lancet Gastroenterology & Hepatology

176

104

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Summary Background The increased risk of colorectal cancer in ulcerative colitis is well known. The risk of sporadic colorectal cancer in Asian populations is considered low and risk estimates of colorectal cancer related to ulcerative colitis from Asia vary. This meta-analysis is an Asian perspective on the risk of colorectal cancer related to ulcerative colitis. Methods We searched PubMed and Embase for terms related to colorectal cancer in ulcerative colitis from inception to July 1, 2016. The search for published articles was done by country for all countries in Asia. We included studies with information on the prevalence and cumulative risk of colorectal cancer at various timepoints. A random-effects meta-analysis was done to calculate the pooled prevalence as well as a cumulative risk at 10 years, 20 years, and 30 years of disease. Findings Our search identified 2575 articles; of which 44 were eligible for inclusion. Our analysis included a total of 31 287 patients with ulcerative colitis with a total of 293 reported colorectal cancers. Using pooled prevalence estimates from various studies, the overall prevalence was 0·85% (95% CI 0·65–1·04). The risks for colorectal cancer were 0·02% (95% CI 0·00–0·04) at 10 years, 4·81% (3·26–6·36) at 20 years, and 13·91% (7·09–20·72) at 30 years. Subgroup analysis by stratifying the studies according to region or period of the study did not reveal any significant differences. Interpretation We found the risk of colorectal cancer in Asian patients with ulcerative colitis was similar to recent estimates in Europe and North America. Adherence to screening is therefore necessary. Larger population-based, prospective studies are required for better estimates of the risk.

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Section: Resultsmentioning

confidence: 99%

“…The mean duration of ulcerative colitis was 8·0 years (SD 3·04). Five studies 21,43,44,51,55 reported no colorectal cancer (table). …”

Section: Resultsmentioning

confidence: 99%

Risk of colorectal cancer in Asian patients with ulcerative colitis: a systematic review and meta-analysis

Bopanna

Ananthakrishnan

Kedia

et al. 2017

The Lancet Gastroenterology & Hepatology

176

104

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“…Unlike Europe and North America, there are no data for a north–south or an east–west divide in the Asia-Pacific region. There is also a lack of population-based studies evaluating race or ethnicity in developing nations, although there is some suggestion that certain ethnic groups such as Indians are more susceptible to UC compared with Chinese or native Malay within the same country 49 50. The differences between ethnicities within one country may reflect differences in genetic susceptibility, living conditions and/or diet 51…”

Section: Geographymentioning

confidence: 99%

Geographical variability and environmental risk factors in inflammatory bowel disease

Bernstein

Vatn

et al. 2013

Gut

506

332

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The changing epidemiology of inflammatory bowel disease (IBD) across time and geography suggests that environmental factors play a major role in modifying disease expression. Disease emergence in developing nations suggests that epidemiological evolution is related to westernisation of lifestyle and industrialisation. The strongest environmental associations identified are cigarette smoking and appendectomy, although neither alone explains the variation in incidence of IBD worldwide. Urbanisation of societies, associated with changes in diet, antibiotic use, hygiene status, microbial exposures and pollution have been implicated as potential environmental risk factors for IBD. Changes in socioeconomic status might occur differently in different geographical areas and populations and, consequently, it is important to consider the heterogeneity of risk factors applicable to the individual patient. Environmental risk factors of individual, familial, community-based, country-based and regionally based origin may all contribute to the pathogenesis of IBD. The geographical variation of IBD provides clues for researchers to investigate possible environmental aetiological factors. The present review aims to provide an update of the literature exploring geographical variability in IBD and to explore the environmental risk factors that may account for this variability.

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“…The lowest incidence was reported from Xian, China (0.54 per 100,000 individuals). Besides geographical differences, in multiracial countries such as Malaysia and Singapore, Indians appear to be more susceptible to ulcerative colitis (UC) than their Chinese and Malay counterparts within the same country [2,3], which supports the genetic underpinning of the disease. Although still relatively uncommon in Asia as compared with the West, various time trend studies have shown that the incidence of IBD is on the rise [4].…”

Section: Epidemiologymentioning

confidence: 99%

The Same Intestinal Inflammatory Disease despite Different Genetic Risk Factors in the East and West?

Lui

2016

Inflamm Intest Dis

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Background: Inflammatory bowel disease (IBD) is a chronic inflammatory disease with unknown etiology. It is likely caused by a complex interplay between genetic, immunologic and environmental factors. Although IBD is still relatively uncommon in Asia, a multitude of studies have shown that it is an emerging disease around the world. Recent insights have highlighted both the similarities and differences amongst Asian and Western IBD patients. Summary: The annual incidence of IBD in the East is still low compared with the West, but there are differences between different regions of Asia. Time trend studies have shown that the incidence of IBD is on the rise. Some notable differences in the clinical manifestations of IBD between the East and West have also been noted. ‘Westernization' of lifestyle may encompass various social and environmental changes that account for the emergence of IBD in our population, although genetics also plays a role in disease pathogenesis. Diagnosis and treatment challenges include limited access to medical care in certain areas, limited availability and high cost of medications, lack of insurance reimbursement, paucity of multidisciplinary teams for the management of complicated IBD cases, and a high prevalence of endemic infections. Currently, the risk of colorectal cancer is lower in the East than in the West, but cancer rates will likely approach that of the West in the future as the prevalence of IBD continues to rise. Key Messages: Measures to improve access to diagnostic tools, increase the availability of medication, and provide adequate multidisciplinary care for IBD patients will become increasingly important in Asia. Differences between the East and West will provide a unique opportunity for global collaboration in basic and clinical research to further our understanding of the disease entity and also provide more locoregional data to healthcare providers and policymakers to make informed decisions and policy changes when tackling the rising burden of IBD in Asia.

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Demography and clinical course of ulcerative colitis in a multiracial Asian population: A nationwide study from Malaysia

Cited by 36 publications

References 23 publications

Risk of colorectal cancer in Asian patients with ulcerative colitis: a systematic review and meta-analysis

Risk of colorectal cancer in Asian patients with ulcerative colitis: a systematic review and meta-analysis

Geographical variability and environmental risk factors in inflammatory bowel disease

The Same Intestinal Inflammatory Disease despite Different Genetic Risk Factors in the East and West?

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