Changing phenotype, early clinical course and clinical predictors of inflammatory bowel disease in Sri Lanka: a retrospective, tertiary care-based, multi-centre study.

Autor: Niriella MA; Department of Clinical Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. maduniln@yahoo.co.uk., Liyanage IK; Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.; University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka., Kodisinghe SK; University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka., De Silva AP; Department of Clinical Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka., Jayatissa AVGAM; Department of Clinical Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka., Navarathne NMM; Gastroenterology Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka., Peiris RK; Gastroenterology Unit, Colombo South Teaching Hospital, Kalubovila, Sri Lanka., Kalubovila UP; Gastroenterology Unit, Teaching Hospital, Kandy, Sri Lanka., Kumarasena SR; Gastroenterology Unit, Teaching Hospital Karapitiya, Galle, Sri Lanka., Jayasekara RW; Human Genetics Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka., de Silva HJ; Department of Clinical Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
Jazyk: angličtina
Zdroj: BMC gastroenterology [BMC Gastroenterol] 2021 Feb 16; Vol. 21 (1), pp. 71. Date of Electronic Publication: 2021 Feb 16.
DOI: 10.1186/s12876-021-01644-5
Abstrakt: Background: Inflammatory bowel disease (IBD) is increasing in the Asia-Pacific region, with changes in disease phenotype and course. We aimed to assess the changing phenotypes of IBD over ten years, describe the early clinical course (ECC) and identify the clinical predictors (CP) of poor outcomes among a large, multi-centre, cohort of Sri Lankan IBD patients.
Methods: We included patients [diagnosed between June/2003-December/2009-Group-1(G1), January/2010-June/2016-Group-2(G2)] with ulcerative colitis (UC) and Crohn disease (CD) from five national-referral centres. Changing phenotype from G1 to G2, ECC (disease duration < 3-years) and CP of poor outcomes (disease duration ≥ 1-year) was assessed. Poor outcomes were complicated-disease (CompD-stricturing/penetrating-CD, extensive-UC/pancolitis, perforation/bleeding/colectomy/malignancy) and treatment-refractory disease (TRD-frequently-relapsing, steroid-dependent/refractory and biologic use).
Results: 375 (UC-227, CD-148) patients were recruited. Both G1/G2 had more UC than CD (77% vs 23%, 54.5 vs 45.5 respectively, p < 0.01). Increase of CD from G1-to-G2 was significant (23-45.4%, p < 0.001). In both groups, left-sided colitis (E2) and ileo-colonic (L3)/non-stricturing, non-penetrating disease behaviour (B1) CD predominated. Extensive-colitis (E3) (36.4% vs 22.7, p < 0.05) and stricturing-CD (B2) (26.1% vs 4.0%, p < 0.01) was commoner in G1. ECC was assessed in 173-patients (UC-94, CD-79). Aggressive disease behaviour and TRD were low among both UC and CD. Immunomodulator use was significantly higher among CD than UC (61.5% vs 29.0% respectively, p < 0.01). Anti-TNF use was low among both groups (UC-3.2%, CD-7.7%). Disease complications among UC [bleeding (2.1%), malignancy-(1.1%), surgery-(2.1%)] and CD [stricture-(3.9%), perforation-(1.3%), malignancy-(1.3%), surgery-(8.9%)] were generally low. CPs were assessed in 271-patients (UC-163, CD-108). Having a family history of IBD (for UC), extraintestinal manifestation (EIM), severe disease at presentation, being in younger age categories and severe disease at presentation, (for both UC and CD) predicted poor outcomes.
Conclusion: There was an increase in CD over time without change in disease phenotype for both UC and CD. A relatively benign ECC was observed. Family history (UC), EIMs (UC/CD), severe disease at presentation (UC/CD), younger age (CD/UC) CPs of poor outcomes.
Databáze: MEDLINE
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