Progression of Inflammatory Bowel Diseases Throughout Latin America and the Caribbean: A Systematic Review

Abstract

BACKGROUND & AIMS:The incidence of inflammatory bowel diseases (IBD) is increasing in Latin America. We performed a systematic review to identify clinical and epidemiologic features of IBD in Latin America (including Mexico, Central America, and South America) and the Caribbean. METHODS:We searched MEDLINE, EMBASE, and SciELO databases for clinical or epidemiologic studies of Crohn's disease (CD) or ulcerative colitis (UC) from Latin American and Caribbean countries and territories that reported incidence, prevalence, ratio of UC:CD, IBD phenotype, and treatment, through September 12, 2018. Data were extracted from 61 articles for analysis. RESULTS:The incidence and prevalence of IBD have been steadily increasing in Latin America and the Caribbean. The incidence of CD in Brazil increased from 0.08 per 100,000 person-years in 1988 to 0.68 per 100,000 person-years in 1991-1995 to 5.5 per 100,000 person-years in 2015. The highest reported prevalence of IBD was in Argentina, in 2007, at 15 and 82 per 100,000 personyears for CD and UC, respectively. The ratio of UC:CD exceeded 1 in all regions throughout Latin America and the Caribbean with the exception of Brazil. Treatment with tumor necrosis factor antagonists increased steadily for patients with CD (43.4% of all patients in Brazil were treated in 2014) but less so for patients with UC (4.5% of all patients were treated in 2014). Surgery for IBD decreased with time. In Chile, surgeries were performed on 57.0% of patients with CD and 18.0% of patients with UC during the period of 1990-2002; these values decreased to 38.0% and 5.0%, respectively, during the period of 2012-2015. In Peru, 6.9% of patients with UC received colectomies in the period of 2001-2003 and 6.2% in 2004-2014. CONCLUSIONS:In a systematic review, we found the incidence of IBD to be increasing throughout Latin America and the Caribbean. Population-based epidemiology studies are needed to evaluate the increase in IBD in these regions, which differ from other global regions in climate, culture, demographics, diet, healthcare delivery and infrastructure, and socioeconomic status.

Epidemiological profile of inflammatory bowel disease in Caxias do Sul, Brazil: a cross-sectional study

“…13 These findings are compatible with the data from a recently published systematic review, which found that the prevalence of inflammatory bowel disease has been increasing in Latin America and Carribbean. 14 Ulcerative colitis was more prevalent than Crohn's disease, which is consistent with previous data from other countries, but discordant with previous Brazilian studies. 1,7 Unlike in some older Brazilian case series, which showed predominance of proctosigmoiditis and left hemicolitis, 7 pancolitis predominated in the present study.…”

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

“…Historically, IBD typically emerges in a population as cases of ulcerative colitis, eventually followed by cases of Crohn's disease. Over time, Crohn's disease becomes more commonly diagnosed as the incidence approximates and, in some cases, surpasses that of ulcerative colitis 49 . For example, in Malaysia the ulcerative colitis to Crohn's disease ratio was 5:1 in the 1980s and fell to 1.7:1 from 2010 to 2018 (reF.…”

Research in inflammatory bowel disease in Brazil: a step forward towards patient care

“…Over the last decades, the incidence and prevalence of IBD seem to be increasing in our country, in a profile that seems different than other Latin American countries (7,8) . As compared to countries such as Colombia, Mexico, and Argentina, the UC:CD ratio in Brazil is proximal to one in different areas of the federation, a similar disease distribution as countries from North America and Europe (9) . This means that we have more cases of CD than other countries in the same continent, a characteristic that is observed in more developed areas of the world.…”