NEW YORK (Reuters Health) – As newly industrialized countries have become more westernized, inflammatory bowel disease (IBD) has emerged and its incidence is rising rapidly, researchers say.
“The increase in incidence of IBD in regions other than the Western world is alarming,” Dr. Siew Ng of the University of Hong Kong, China, told Reuters Health by email. “It is a ‘new’ disease not seen a generation ago in newly industrialized countries; therefore, many primary care doctors in these countries may not recognize it.”
Dr. Ng and colleagues systematically reviewed the literature from 1990 to 2016 and ultimately analyzed 119 studies on IBD incidence and 69 on its prevalence. They also created interactive maps to visualize the resulting data (http://bit.ly/2z9vzkW).
As reported online October 16 in The Lancet, incidence rates have shifted since 1990 in Western countries, with 73% of studies on Crohn’s disease and 83% of studies on ulcerative colitis showing stable or falling rates.
However, disease burden remains high, with prevalence surpassing 0.3% in North America, Oceania, and most European countries. The highest reported prevalence values were in Europe (505 ulcerative colitis cases per 100,000 in Norway and 322 Crohn’s cases per 100,000 in Germany) and North America (286 ulcerative colitis cases per 100,000 in the U.S. and 319 Crohn’s cases per 100,000 in Canada).
Meanwhile, incidence has been rising in newly industrialized countries in Africa, Asia and South America. For example, in Brazil, the annual percentage change (APC) was +11.1% for Crohn’s disease and +14.9% for ulcerative colitis from 1998 to 2012; in Taiwan, APCs were +4.0% and +4.8%, respectively, from 1998 to 2008.
“Physician education is important to raise awareness and prevent delay in diagnosis, (and) timely treatment can help delay disease progression,” Dr. Ng said.
“Although the cause of IBD is unknown, westernization of diet and urbanization may play a role,” she added. “As it is anticipated that the disease will continue to rise in newly industrialized countries – for instance, in Hong Kong, the incidence has risen 30-fold in three decades – we believe now is a golden time to identify the cause and to lessen the disease burden on our healthcare system.”
Study coauthor Dr. Gilaad Kaplan of the University of Calgary in Canada told Reuters Health in the same email, “To address the staggering increase in the burden of IBD, gastroenterology clinics will need to partner with primary care physicians to develop innovative, team-based approaches to delivering healthcare for these patients.”
Dr. James Marion, director of education and outreach at the IBD center at Mount Sinai Hospital in New York City, said in an email to Reuters Health that the study “deftly uses our improved epidemiologic monitoring tools to provide a clear snapshot of the global reach of IBD in the 21st century.”
“Clearer understanding about the essential nature of these diseases is needed to lead to prevention strategies and less costly treatments,” he stated.
Dr. Adam Ehrlich, co-medical director of the IBD program at Temple University in Philadelphia, told Reuters Health by email, “In the United States, it is important for providers to consider IBD in patients who may present with symptoms consistent with the disease but originate from parts of the world that are not typically associated with these diseases.”
“IBD is not the first GI disease to be tied to Western culture,” he added. “Diverticulosis, for example, is very common in the U.S. but rare in East Asia. When patients immigrate to the U.S., their risk of diverticulosis increases. While each ethnicity presumably has some genetic risk for IBD, this suggests an environmental risk factor.”
“Urbanization seems to be related,” he noted, “but it is not clear what underlying factor would be the crucial piece – pollution or toxic exposures or hygiene. I would also consider the Western diet to be a likely factor” through its impact on a patient’s microbiome.
“Ongoing research into these topics will hopefully help to elucidate the causes for the increasing rates in developing nations,” Dr. Ehrlich concluded.
In an editorial, Dr. Michael Kamm of the University of Melbourne, Australia, notes, “Investigation of diseases where they are emerging rapidly provides one of the best opportunities to further identify causative factors.”
SOURCES: http://bit.ly/2gyqUhh and http://bit.ly/2gzGUzu
Lancet 2017.
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