Prevalence of extraintestinal manifestations in Korean inflammatory bowel disease patients

Abstract

BackgroundThe prevalence of inflammatory bowel disease (IBD) in South Korea is increasing. Although extraintestinal manifestations (EIMs) are an important factor in the clinical outcomes of IBD patients, EIMs have not yet been investigated in Korea. Thus, we conducted a cross-sectional study to assess the prevalence of EIMs in Korean IBD patients.MethodsThe 2014 claims data from the National Health Insurance System (NHIS) of Korea were used. IBD patients were identified by codes for Crohn disease (CD) and ulcerative colitis (UC) in the NHIS registration system for rare or intractable diseases. International Classification of Diseases, Tenth Edition codes were used to identify EIM cases. To estimate the prevalence of EIMs in the general population of Korea, we used national sample data. Standardized prevalence ratios (SPRs) were calculated to compare the prevalence rates of EIMs among IBD patients to those among the general population of Korea.ResultsA total of 13,925 CD patients and 29,356 UC patients were identified. CD and UC patients were different in terms of demographics and utilization of medication. Among the 17 EIMs investigated, pyoderma gangrenosum, osteomalacia, Sweet syndrome, and scleritis were observed in very few patients. The SPRs were greater than 1 for all EIMs. Aphthous stomatitis, rheumatoid arthritis, and osteoporosis were highly prevalent in both CD and UC patients, but the SPRs of the EIMs were not high.ConclusionThe study confirmed that EIMs are more prevalent among IBD patients than among the general population of Korea. The prevalence of EIMs in IBD patients suggests the need for greater attention and effort in clinical practice.

Pathogenesis and clinical perspectives of extraintestinal manifestations in inflammatory bowel diseases

“…EIMs are defined in patients with IBD when an inflammatory pathology is located outside the intestine, the pathogenesis of which depends on the extension/translocation of immune pathways from the intestine, is an independent inflammatory event sustained by IBD, or shares a common environmental or genetic predisposition with IBD. 1 EIMs can be divided into 3 categories: EIMs directly related to bowel disease activity, including episcleritis, erythema nodosum (EN), www.irjournal.org agnosis and sex 3,4 and is reported to be 23.0% in CD and 24.4% in UC, according to data from the National Health Insurance System of Korea. 3 Up to 50% of patients with IBD experience at least one EIMs, which can develop even before the diagnosis of IBD.…”

Nationwide validation study of diagnostic algorithms for inflammatory bowel disease in Korean National Health Insurance Service database

“…Therefore, it is generally expected that the use of RID codes can be another way to increase the specificity of the diagnostic algorithms within the NHIS database. In fact, although the RID codes for IBD have been used in several studies, the diagnostic performance of such codes have not been clearly depicted . In this study, we first presented the performance of algorithms that include the RID codes for IBD diagnosis.…”

“…No other biological drugs or newer small molecule agents were used during the study period. Finally, we developed a total of 44 algorithms to identify cases of IBD, including existing definitions used in recent Korean studies …”

“…Given this unique strength in capturing all disease cases of interest, many studies using the NHIS database have been conducted and published, and additional studies are being added to the available literature . Several studies involving the Korean population with IBD have also been published in recent years; however, there is a growing concern over the study methodology being applied, particularly the use of heterogeneous across‐study case definitions. Such heterogeneity of the definition of IBD may cause serious problems in the interpretation of interstudy differences, and eventually hamper the credibility of all studies being conducted.…”

“…Such heterogeneity of the definition of IBD may cause serious problems in the interpretation of interstudy differences, and eventually hamper the credibility of all studies being conducted. We found six different diagnostic codes or algorithms from seven studies published during the past 4 years (2015–2018, Table ), two of which were conducted by the same investigators . In most of these studies, a proper reference for their own operational definition was not cited, or the authors did not provide a detailed method and/or results to define patients with IBD.…”