Clinical features of ulcerative colitis in Korea

Systematic review with meta-analysis: Time to diagnosis and the impact of delayed diagnosis on clinical outcomes in inflammatory bowel disease

BACKGROUND

The impact of diagnostic delay on the clinical course of inflammatory bowel disease (IBD) remains uncertain.

AIM

To perform a systematic review of time to diagnosis and the impact of delayed diagnosis on clinical outcomes in Crohn's disease (CD) and ulcerative colitis (UC).

METHODS

We searched EMBASE and Medline from inception to 30th November 2022 for studies reporting diagnostic interval, from symptom onset to IBD diagnosis. We calculated the median, interquartile range (IQR) and pooled weighted median, of median diagnostic intervals of eligible studies. We defined delayed diagnosis as individuals above the 75th centile of longest time to diagnosis in each study. Using random effects meta-analysis, we pooled odds ratios (ORs) with 95% confidence intervals (CI) for studies reporting clinical outcomes, according to delayed diagnosis.

RESULTS

One hundred and one studies representing 112,194 patients with IBD (CD = 59,359; UC = 52,835) met inclusion criteria. The median of median times to diagnosis was 8.0 (IQR: 5.0-15.2) and 3.7 months (IQR: 2.0-6.7) in CD and UC, respectively. In high-income countries, this was 6.2 (IQR: 5.0-12.3) and 3.2 months (IQR: 2.2-5.3), compared with 11.7 (IQR: 8.3-18.0) and 7.8 months (IQR: 5.2-21.8) in low-middle-income, countries, for CD and UC respectively. The pooled weighted median was 7.0 (95% CI: 3.0-26.4) and 4.6 (95% CI: 1.0-96.0) months, for CD and UC respectively. Eleven studies, representing 6164 patients (CD = 4858; UC = 1306), were included in the meta-analysis that examined the impact of diagnostic delay on clinical outcomes. In CD, delayed diagnosis was associated with higher odds of stricturing (OR = 1.88; CI: 1.35-2.62), penetrating disease (OR = 1.64; CI: 1.21-2.20) and intestinal surgery (OR = 2.24; CI: 1.57-3.19). In UC, delayed diagnosis was associated with higher odds of colectomy (OR = 4.13; CI: 1.04-16.40).

CONCLUSION

Delayed diagnosis is associated with disease progression in CD, and intestinal surgery in both CD and UC. Strategies are needed to achieve earlier diagnosis of IBD.

Renal involvement in children and adolescents with inflammatory bowel disease

Purpose

The incidence of inflammatory bowel disease (IBD) is rapidly increasing, and several reports have described the renal complications of IBD. We sought to evaluate the clinical manifestations of renal complications in children with IBD in order to enable early detection and prompt treatment of the complications.

Methods

We retrospectively reviewed the medical records of 456 children and adolescents aged <20 years who had been diagnosed with IBD since 2000. We analyzed patient age, sex, medication use, IBD disease activity, and clinical manifestations of renal symptoms.

Results

Our study comprising 456 children with IBD included 299 boys (65.6%) and 157 girls (34.4%). The study included 346 children with Crohn disease and 110 children with ulcerative colitis. The incidence of kidney-related symptoms was 14.7%, which was significantly higher than that in normal children. We observed 26 children (38.8%) with isolated hematuria, 30 children (44.8%) with isolated proteinuria, and 11 children (16.4%) with hematuria and concomitant proteinuria. A renal biopsy was performed in 7 children. Histopathological examination revealed immunoglobulin A nephropathy in 5 children (71.4%). All children presented with mild disease and well-controlled disease activity of IBD.

Conclusion

Children with IBD are more likely to show kidney-related symptoms than healthy children and adolescents are. Therefore, regular screening of urine and evaluation of renal function in such children are necessary for early detection of renal complications.

Clinical epidemiology of ulcerative colitis in Mexico: a single hospital-based study in a 20-year period (1987-2006)

BACKGROUND

Ulcerative colitis (UC) is a chronic disease with a heterogeneous clinical evolution. The prevalence and incidence of UC vary widely and depend on multiple factors including ethnicity and geographic location.

GOAL

To determine the frequency of new cases of UC and their clinical characteristics in a large cohort from a referral hospital in Mexico City.

STUDY

Patients with confirmed diagnosis of UC were included during a period between January 1987 and December 2006. Demographic and clinical data were collected from medical records.

RESULTS

A total of 848 new cases of UC were diagnosed during a 20-year period. All the patients had endoscopic and histologic confirmation. The mean of annual new UC cases increased from 28.8 in the first period (1987 to 1996) to 76.1 in the second period (1997 to 2006) (P<0.00008). The incidence of new cases increased 2.6-fold comparing both periods of time. This study consisted of 467 females and 382 males, with a mean age at diagnosis of 31.3+/-12.3 years. The clinical manifestations were pancolitis (59.1%), and extraintestinal manifestations (41.5%). Most of the patients, 762 (89.8%) were taking sulfasalazine or 5-aminosalicylic acid, 282 (33.3%) used oral or systemic steroids, 237 (28%) were taking azathioprine.

CONCLUSIONS

The frequency of new UC cases has increased significantly in the last 10 years in Mexico, largely due to the unique genetic make-up and the environmental factors (infectious diseases including parasites) not found in other countries.

Ulcerative colitis in China: retrospective analysis of 3100 hospitalized patients

BACKGROUND AND AIMS

This retrospective study analyzed the clinical characteristics of hospitalized patients with ulcerative colitis (UC) in China.

METHODS

A total of 3100 hospitalized patients with UC admitted to 23 hospitals in China from 1990 to 2003 were retrospectively investigated and their clinical characteristics were analyzed.

RESULTS

A male/female ratio of 1.34/1.00 was found in the 3100 patients, who had an average age of 44 +/- 15.1 years at diagnosis. Of the patients, 2972 (95.9%) had active UC. Active UC was mild in 35.4% of the 2972 patients, moderate in 42.9% and severe in 21.7%. Of the 2726 patients with a description of their lesion extent, 14.8% had proctitis, 26.4% had proctosigmoiditis, 25.0% had left-sided colitis, 6.3% had extensive colitis, 25.8% had pancolitis and 1.7% had regional colitis. The predominant complaints of the patients with UC were bloody diarrhea (48.2%), abdominal pain (67.3%) and mucus stools (58.4%). Among these patients, 13.6% had extraintestinal manifestations and 9.6% had related complications. A differential diagnosis was difficult to make, as there were 19 varieties of the disease; infectious enterocolitis had a misdiagnosis rate of 22.9% before admission. The main medications for UC in China were aminosalicylates (66.8%) and steroids (42.8%). Only 94 (3%) of the patients required colectomy and only 19 (0.6%) died of UC.

CONCLUSIONS

Compared with UC in Western countries, ulcerative colitis in China has some differences in clinical characteristics. Therefore, a further population-based epidemiological study is required to determine the prevalence and incidence rates of UC in China.

Clinical features and natural history of ulcerative colitis in Korea

BACKGROUND

The clinical characteristics of ulcerative colitis (UC) in Asian populations have not been well characterized. We therefore investigated the clinical features and natural history of UC in Korea.

METHODS

We retrospectively analyzed 304 Korean patients with UC first diagnosed at the Asan Medical Center between June 1989 and August 2005.

RESULTS

The male-to-female ratio of the patients was 0.94:1, and their median age at diagnosis was 40.0 years (range, 12-72 years). At diagnosis, proctitis was noted in 134 patients (44.1%), left-sided colitis in 69 patients (22.7%), and extensive colitis in 101 patients (33.2%). Disease activity at diagnosis was mild in 149 patients (49.0%), moderate in 125 patients (41.1%), and severe in 26 patients (8.6%). In addition, 4 asymptomatic patients (1.3%) were detected as a result of a screening colonoscopy. Clinical remission after the first attack was documented in 97.4% of patients. The cumulative relapse rate after 1, 5, and 10 years was 30.2%, 72.0%, and 88.4%, respectively. The cumulative risk of proximal extension in patients with proctitis or left-sided colitis was 33.0% after 5 years and 44.5% after 10 years. The cumulative probability of colectomy was 2.0% after 1 year, 2.8% after 3 years, and 3.3% after 5 to 15 years. The cumulative survival rate after 1, 5, and 10 years was 100%, 99.4%, and 97.4%, respectively.

CONCLUSIONS

The clinical features of Korean UC patients at diagnosis are similar to those of Westerners. However, UC in Koreans may have a milder course than in Westerners, as indicated by the lower rate of colectomy among Koreans.

Inflammatory bowel disease in Iran: a review of 457 cases

BACKGROUND AND AIMS

Inflammatory bowel disease (IBD) was believed to be infrequent in Iran; however, unofficial reports have confessed the continuing rise in IBD in our country.

METHODS

Demographic and clinical features, extraintestinal manifestations, extension of disease and complications of 401 patients with ulcerative colitis (UC), 47 with Crohn's disease (CD), and nine with indeterminatn colitis (IC) were assessed retrospectively. The exact course of physicians' visits of 250 IBD patient was asked through face-to-face interview.

RESULTS

Mean age at diagnosis was 31.9 years in UC and 30.5 years in CD patients. The male to female ratio was 0.8 for UC and 1.3 for CD. The percentage of CD and UC patients who were non-smokers was 82.9 and 84.5%, respectively. Patients with UC presented with rectal bleeding (41.9%), whereas those with CD complained of abdominal pain (46.9%). Among UC patients, proctosigmoid was affected in 51.9%. Colorectal cancer was diagnosed in two patients. The mean lag time between the onset of symptoms and definite diagnosis was 13.9 and 17.7 months for UC and CD patients, respectively. A total of 32.4% of patients with IBD had at least one of the five major extra-intestinal diseases.

CONCLUSION

The demographic and clinical picture of IBD is more or less the same as that of other developing countries; however, the rarity of CD in Iran is noted. Although the true epidemiologic profile of IBD in Iran is still unknown, it is not as rare as previously thought, and it seems as if gradual adoption of a Western lifestyle may be associated with the continuing rise in IBD.

Epidemiology of inflammatory bowel disease in Asia

Studies of Asians in Asia show relatively low incidence rates for ulcerative colitis and Crohn's disease compared with North America and Europe. The prevalence of ulcerative colitis in migrant South Asians in Europe is similar to Europeans, whereas the prevalence of Crohn's disease for migrant South Asians in Europe is decreased compared with Europeans. The prevalence for both ulcerative colitis and Crohn's disease in Japan and Korea is relatively low. There are no obvious differences in age or sex distribution or rates of familial aggregation, and there are no significant differences in the clinical characteristics and natural history of ulcerative colitis and Crohn's disease in Asians compared with other racial groups with inflammatory bowel disease.