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

Abstract

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.

Temporal trends in surgery for Crohn’s disease: a ten-year single-center retrospective study

“…Additionally, differences in the clinical manifestations have been observed between the East and West. For instance, CD tends to have a higher male predominance, more perianal involvement, and fewer extraintestinal manifestations in Asia [5]. This study examined the clinical data of patients who underwent surgery, revealing a male-to-female ratio of 2:1, which was higher than that reported in US literature but consistent with previous ndings in China [6 , 7].…”

Asian Organization for Crohn's and Colitis and Asia Pacific Association of Gastroenterology practice recommendations for medical management and monitoring of inflammatory bowel disease in Asia

“…The highest incidence of IBD has been reported in East Asia (Korea, Japan, and China) and South Asia (India). Also, differences in the clinical manifestations of IBD between the East and West have been noted: in Asia, there is a higher male predominance of Crohn's disease (CD); more perianal involvement in CD; and fewer extraintestinal manifestations and worse clinical outcomes among older‐onset patients with ulcerative colitis (UC) 1,2 . There are also different genetic risk factors between the East and West: nucleotide oligomerization domain (NOD2) variants present in Caucasians have not been identified in many Asian ethnicities (Han Chinese, Japanese, Korean, Indian, and Malaysian), and among Asian populations, tumor necrosis factor (TNF) superfamily 15 polymorphisms was identified as a CD‐susceptible gene and the TNF‐α‐308 polymorphism as a UC‐susceptible gene.…”

A phase I/II clinical trial of ex-vivo expanded human bone marrow derived allogeneic mesenchymal stromal cells in adult patients with perianal fistulizing Crohn’s Disease

“…This suggests that there could be potential therapeutic differences between AMSCs and BMSCs in the management of perianal fistulizing CD which needs to be further explored. Genetic and phenotypic differences in inflammatory bowel disease between Western and Asian population may also influence the efficacy of MSCs [31][32][33]. Therefore, our study is a valuable addition to the existing limited literature.…”