Is the emergence of inflammatory bowel disease a prime example of “the third epidemiological transition”?

Kedia, Saurabh; Ahuja, Vineet

doi:10.1007/s12664-018-0852-y

Cited by 20 publications

(13 citation statements)

References 24 publications

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“…South Asian and South East Asian countries are at the crossroads of epidemiologic transition[1,2] with the decline in the incidence of infectious diseases and an increase in chronic non-infectious diseases, and one such transition is exemplified by the chronic granulomatous disorders of the intestine: intestinal tuberculosis (ITB), an infectious disease and Crohn’s disease (CD), a sub-type of inflammatory bowel disease (IBD). Both have different etiologies, but similar presentations and are difficult to differentiate[3].…”

Section: Introductionmentioning

confidence: 99%

Differentiating Crohn’s disease from intestinal tuberculosis

Kedia

Das

Madhusudhan

et al. 2019

WJG

Self Cite

143

109

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Differentiating Crohn’s disease (CD) and intestinal tuberculosis (ITB) has remained a dilemma for most of the clinicians in the developing world, which are endemic for ITB, and where the disease burden of inflammatory bowel disease is on the rise. Although, there are certain clinical (diarrhea/hematochezia/perianal disease common in CD; fever/night sweats common in ITB), endoscopic (longitudinal/aphthous ulcers common in CD; transverse ulcers/patulous ileocaecal valve common in ITB), histologic (caseating/confluent/large granuloma common in ITB; microgranuloma common in CD), microbiologic (positive stain/culture for acid fast-bacillus in ITB), radiologic (long segment involvement/comb sign/skip lesions common in CD; necrotic lymph node/contiguous ileocaecal involvement common in ITB), and serologic differences between CD and ITB, the only exclusive features are caseation necrosis on biopsy, positive smear for acid-fast bacillus (AFB) and/or AFB culture, and necrotic lymph node on cross-sectional imaging in ITB. However, these exclusive features are limited by poor sensitivity, and this has led to the development of multiple multi-parametric predictive models. These models are also limited by complex formulae, small sample size and lack of validation across other populations. Several new parameters have come up including the latest Bayesian meta-analysis, enumeration of peripheral blood T-regulatory cells, and updated computed tomography based predictive score. However, therapeutic anti-tubercular therapy (ATT) trial, and subsequent clinical and endoscopic response to ATT is still required in a significant proportion of patients to establish the diagnosis. Therapeutic ATT trial is associated with a delay in the diagnosis of CD, and there is a need for better modalities for improved differentiation and reduction in the need for ATT trial.

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Section: Introductionmentioning

confidence: 99%

Differentiating Crohn’s disease from intestinal tuberculosis

Kedia

Das

Madhusudhan

et al. 2019

WJG

Self Cite

143

109

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“…This final stage is a proposed anthropological explanation for the rise in chronic inflammatory conditions 7 . In a 2018 editorial, Kedia and Ahuja postulated that IBD is an example of Omran's final stage 8 .…”

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confidence: 99%

The four epidemiological stages in the global evolution of inflammatory bowel disease

Kaplan

Windsor

2020

Nat Rev Gastroenterol Hepatol

734

428

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Inflammatory bowel disease (IBD) is a global disease; its evolution can be stratified into four epidemiological stages: Emergence, Acceleration in Incidence, Compounding Prevalence and Prevalence Equilibrium. In 2020, developing countries are in the Emergence stage, newly industrialized countries are in the Acceleration in Incidence stage, and Western regions are in the Compounding Prevalence stage. Western regions will eventually transition to the Prevalence Equilibrium stage, in which the accelerating prevalence levels off as the IBD population ages and possibly as a result of an unexpected rise in mortality during the COVID-19 pandemic. Mitigating the global burden of IBD will require concerted efforts in disease prevention and health-care delivery innovations that respond to changing demographics of the global IBD population. In this Perspective, we summarize the global epidemiology of IBD and use these data to stratify disease evolution into four epidemiological stages.

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“…8 Consistent with this trend, the changing epidemiology of IBD on the global map has been referred to as a prime example of "the third epidemiological transition." 9 The rise in disease burden has prompted the establishment of various regional and national IBD disease registries over the past few years. The Indian Society of Gastroenterology (ISG) Task Force on IBD has previously conducted a multicenter survey and collated data on the clinical spectrum of IBD from five zones (North, Central, West, East, and South) across the country in the year 2012.…”

Section: Introductionmentioning

confidence: 99%

“…A recent population‐based study conducted in the United States with an objective of estimating the prevalence of IBD in patients of different ethnicities concluded that residents of Indian ancestry had a greater risk for all types of IBD than other American populations 8 . Consistent with this trend, the changing epidemiology of IBD on the global map has been referred to as a prime example of “the third epidemiological transition.” 9 …”

Section: Introductionmentioning

confidence: 99%

Inflammatory bowel diseases in Tamil Nadu: A survey of demographics, clinical profile, and practices

et al. 2021

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BackgroundInflammatory bowel disease (IBD) is increasingly diagnosed in South Asia. This survey by the Tamil Nadu Chapter of the Indian Society of Gastroenterology (TNISG) documents the demography, clinical profile, and therapeutic practices related to IBD in Tamil Nadu.MethodsTNISG members from 32 institutions completed an online cross‐sectional questionnaire on IBD patients from March 2020 to January 2021.ResultsOf 1295 adult IBD patients, 654 had Crohn's disease (CD), 499 ulcerative colitis (UC), and 42 IBD‐unclassified (IBD‐U). CD and UC showed a unimodal age distribution. A total of 55% were graduates or postgraduates. A positive family history was noted in 30, other risk factors were uncommon. In CD, the pattern of involvement was ileocolonic (42.8%), ileal (34.7%), colonic (18.9%), and upper gastrointestinal (3.5%); while in UC, disease was characterized as extensive (44.9%), left‐sided (41.7%), or proctitis (13.4%). Perineal disease, perianal fistulae, and bowel obstruction were noted in 4.3, 14.0, and 23.5%, respectively, of CD. The most widely used drugs were mesalamine, azathioprine, and corticosteroids. Surgery was undertaken in 141 patients with CD and 23 patients with UC. Of the 138 patients with pediatric IBD (≤16 years), 23 were characterized as very early onset IBD (VEO‐IBD), 27 as early‐onset, and 88 as adolescent IBD. VEO‐IBD were more likely to have a positive family history of IBD and were more likely to have perineal disease and to have the IBD‐U phenotype. Among pediatric IBD patients, corticosteroids, mesalamine, and azathioprine were the most commonly used medications, while 25 pediatric patients received biologics.ConclusionThis study provides important information on demography, clinical profile, and treatment practices of IBD in India.

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Is the emergence of inflammatory bowel disease a prime example of “the third epidemiological transition”?

Cited by 20 publications

References 24 publications

Differentiating Crohn’s disease from intestinal tuberculosis

Differentiating Crohn’s disease from intestinal tuberculosis

The four epidemiological stages in the global evolution of inflammatory bowel disease

Inflammatory bowel diseases in Tamil Nadu: A survey of demographics, clinical profile, and practices

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